MEDICARE: GEORGIA MEDICAL UNITED LLC

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
1	2086S0129X	Vascular Surgery Physician

General Provider Information

NPI Number	:	1871473801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEORGIA MEDICAL UNITED LLC

Provider Business Mailing Address
First Line	:	99 KROG ST NE STE 301
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-2677
Country	:	US
Telephone Number	:	800-991-6117
Fax Number	:	888-812-8191

Provider Business Practice Location Address
First Line	:	99 KROG ST NE STE 301
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-2677
Country	:	US
Telephone Number	:	800-991-6117
Fax Number	:	888-812-8191

Authorized Official
Title or Position	:	VP OF REVENUE CYCLE MANAGEMENT
Name	:	HELEN RIVERA
Credential	:
Telephone Number	:	813-280-0705

Provider Enumeration Date	:	09/02/2025
Last Update Date	:	09/02/2025

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