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NPI Code Detail

MEDICARE: NORTH ATLANTA VASCULAR CLINIC, PC

MEDICARE: NORTH ATLANTA VASCULAR CLINIC, PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12086S0129XVascular Surgery Physician058235GA

General Provider Information

NPI Number : 1619987682
Entity Type Code : Organization
Provider Name (Legal Business Name) : NORTH ATLANTA VASCULAR CLINIC, PC
Provider Business Mailing Address
First Line : 2685 PEACHTREE PKWY STE 320
Second Line :
City : SUWANEE
State : GA
Zip : 30024-1048
Country : US
Telephone Number : 770-771-5269
Fax Number : 770-771-5269
Provider Business Practice Location Address
First Line : 2685 PEACHTREE PKWY STE 320
Second Line :
City : SUWANEE
State : GA
Zip : 30024-1048
Country : US
Telephone Number : 770-771-5269
Fax Number : 770-771-5269
Authorized Official
Title or Position : OWNER/PHYSICIAN
Name : DR. UTHAN VIVEK
Credential : MD
Telephone Number : 770-771-5260
Provider Enumeration Date : 08/09/2006
Last Update Date : 06/28/2021

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