Basic Information
| Provider Information | |||||||||
| NPI: | 1477883338 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SNAPFINGER VASCULAR ACCESS CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 418419 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022418419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106448900 | ||||||||
| FaxNumber: | 4849240053 | ||||||||
| Practice Location | |||||||||
| Address1: | 5246 SNAPFINGER PARK DR | ||||||||
| Address2: | |||||||||
| City: | DECATUR | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300354044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6785336120 | ||||||||
| FaxNumber: | 7703232866 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2009 | ||||||||
| LastUpdateDate: | 01/08/2021 | ||||||||
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| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | GREGG | ||||||||
| AuthorizedOfficialMiddleName: | ARTHUR | ||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR VP OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 7183691444 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ATLANTA NEPHROLOGY REFERRAL CENTER | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 01/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261Q00000X | Y | Ambulatory Health Care Facilities | Clinic/Center |
No ID Information.