Basic Information
| Provider Information | |||||||||
| NPI: | 1255683470 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GEORGIA INTERVENTIONAL AND VASCULAR SPECIALISTS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2015 SPRING RD STE 300 | ||||||||
| Address2: | |||||||||
| City: | OAK BROOK | ||||||||
| State: | IL | ||||||||
| PostalCode: | 605233944 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6307252700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 264 19TH ST NW STE 2240 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303631139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4045321564 | ||||||||
| FaxNumber: | 4045321565 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2012 | ||||||||
| LastUpdateDate: | 02/08/2022 | ||||||||
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| AuthorizedOfficialLastName: | JONES | ||||||||
| AuthorizedOfficialFirstName: | CYNTHIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 6307252737 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/08/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 042261 | GA | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 208600000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 202K00000X | 042261 | GA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Phlebology |
No ID Information.