MEDICARE: ATLANTIC CARDIOVASCULAR & THORACIC SURGEONS, 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	ME36700	FL
2	2086S0129X	Vascular Surgery Physician	ME58979	FL
3	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	ME58979	FL
4	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	ME36700	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962831883
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTIC CARDIOVASCULAR & THORACIC SURGEONS, LLC

Provider Business Mailing Address
First Line	:	1240 W GRANADA BLVD FL 2
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5915
Country	:	US
Telephone Number	:	386-236-6854
Fax Number	:	386-263-2996

Provider Business Practice Location Address
First Line	:	1240 W GRANADA BLVD FL 2
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5915
Country	:	US
Telephone Number	:	862-366-8543
Fax Number	:	862-632-9963

Authorized Official
Title or Position	:	OPERATING MANAGER
Name	:	WILLIAM HAMPTON JOHNSON III
Credential	:	M.D.
Telephone Number	:	386-672-9503

Provider Enumeration Date	:	11/01/2013
Last Update Date	:	01/21/2025

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