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General NPI Number Information
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NPI Number | 1962831883
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Entity Type | Organization
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Legal Business Name | ATLANTIC CARDIOVASCULAR & THORACIC SURGEONS, LLC
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Dates
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Enumeration Date | 11/01/2013
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Last Update Date | 01/21/2025
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Provider Practice Location Address
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Address Line | 1240 W GRANADA BLVD FL 2
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City | ORMOND BEACH
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State | FL
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Zip | 32174-5915
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Country | US
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Telephone | 862-366-8543
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Fax | 862-632-9963
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Provider Business Mailing Address
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Address Line | 1240 W GRANADA BLVD FL 2
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City | ORMOND BEACH
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State | FL
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Zip | 32174-5915
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Country | US
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Telephone | 386-236-6854
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Fax | 386-263-2996
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Authorized Official
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Title or Position | OPERATING MANAGER
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Name | WILLIAM HAMPTON JOHNSON III
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Credential | M.D.
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Telephone | 386-672-9503
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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 | ME36700
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | ME58979
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | ME58979
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | ME36700
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License Number State | FL
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