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General NPI Number Information
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NPI Number | 1063903078
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Entity Type | Organization
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Legal Business Name | SOUTH ATLANTA VASCULAR INSTITUTE, LLC
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Dates
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Enumeration Date | 05/24/2018
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Last Update Date | 05/24/2018
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Provider Practice Location Address
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Address Line | 4714 OAKLEIGH MANOR DR
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-4923
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Country | US
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Telephone | 770-688-5334
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Fax |
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Provider Business Mailing Address
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Address Line | 4714 OAKLEIGH MANOR DR
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-4923
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Country | US
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Telephone | 770-688-5334
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. DAVID WILLIAM ALLISON
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Credential | MD
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Telephone | 770-405-8496
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 70519
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 66855
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License Number State | GA
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