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General NPI Number Information
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NPI Number | 1902273709
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Entity Type | Organization
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Legal Business Name | VASCULAR INSTITUTE OF ATLANTA, LLC
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Dates
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Enumeration Date | 08/27/2015
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Last Update Date | 09/24/2015
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Provider Practice Location Address
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Address Line | 1357 HEMBREE RD SUITE 240
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City | ROSWELL
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State | GA
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Zip | 30076-5722
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Country | US
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Telephone | 470-355-3053
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Fax | 770-716-6225
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Provider Business Mailing Address
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Address Line | 1357 HEMBREE RD SUITE 240
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City | ROSWELL
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State | GA
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Zip | 30076-5722
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Country | US
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Telephone | 470-355-3053
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Fax | 770-716-6225
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Authorized Official
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Title or Position | AGENT/MANAGER
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Name | DR. JOSEPH RICOTTA
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Credential | MD
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Telephone | 470-355-3053
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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 | 064452
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License Number State | GA
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