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General NPI Number Information
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NPI Number | 1255683470
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Entity Type | Organization
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Legal Business Name | GEORGIA INTERVENTIONAL AND VASCULAR SPECIALISTS, PC
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Dates
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Enumeration Date | 10/11/2012
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Last Update Date | 02/08/2022
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Provider Practice Location Address
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Address Line | 264 19TH ST NW STE 2240
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City | ATLANTA
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State | GA
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Zip | 30363-1139
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Country | US
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Telephone | 404-532-1564
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Fax | 404-532-1565
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Provider Business Mailing Address
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Address Line | 2015 SPRING RD STE 300
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City | OAK BROOK
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State | IL
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Zip | 60523-3944
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Country | US
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Telephone | 630-725-2700
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | CYNTHIA JONES
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Credential |
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Telephone | 630-725-2737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 042261
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 202K00000X
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Taxonomy Name | Phlebology Physician
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License Number | 042261
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License Number State | GA
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