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General NPI Number Information
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NPI Number | 1669019394
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Entity Type | Organization
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Legal Business Name | CHAMP VASCULAR, LLC
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Dates
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Enumeration Date | 12/02/2019
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 1825 HIGHWAY 34 E STE 3400
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City | NEWNAN
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State | GA
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Zip | 30265-6423
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Country | US
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Telephone | 770-500-9588
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Fax |
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Provider Business Mailing Address
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Address Line | 124 MORGAN DR
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City | LAGRANGE
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State | GA
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Zip | 30240-6361
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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 | MD OWNER
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Name | OGHENERUKEVWE ODIETE
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Credential |
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Telephone | 770-400-9588
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number |
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License Number State |
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