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General NPI Number Information
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NPI Number | 1558690214
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Entity Type | Organization
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Legal Business Name | GEORGIA VEINCARE LLC
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Dates
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Enumeration Date | 12/09/2009
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Last Update Date | 12/09/2009
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Provider Practice Location Address
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Address Line | 1810 MULKEY RD SUITE 103-B
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City | AUSTELL
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State | GA
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Zip | 30106-1151
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Country | US
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Telephone | 770-980-8970
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Fax | 770-980-8975
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Provider Business Mailing Address
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Address Line | 1810 MULKEY RD SUITE 103-B
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City | AUSTELL
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State | GA
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Zip | 30106-1151
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Country | US
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Telephone | 770-980-8970
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Fax | 770-980-8975
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Authorized Official
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Title or Position | DOCTOR
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Name | MRS. FARAH WILLIAMS
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Credential | M.D.
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Telephone | 770-980-8970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 042194
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License Number State | GA
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