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General NPI Number Information
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NPI Number | 1184879678
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Entity Type | Organization
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Legal Business Name | ROCKDALE VASCULAR AND THORACIC SURGERY, LLC
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Dates
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Enumeration Date | 11/25/2008
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Last Update Date | 11/25/2008
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Provider Practice Location Address
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Address Line | 1368C WELLBROOK CIR NE
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City | CONYERS
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State | GA
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Zip | 30012-3872
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Country | US
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Telephone | 770-785-7195
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Fax | 770-785-7405
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Provider Business Mailing Address
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Address Line | 1368C WELLBROOK CIR NE
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City | CONYERS
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State | GA
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Zip | 30012-3872
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. C JOHN ABLAN
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Credential | MD
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Telephone | 770-785-7195
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number |
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License Number State |
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