Basic Information
| Provider Information | |||||||||
| NPI: | 1619987682 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH ATLANTA VASCULAR CLINIC, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2685 PEACHTREE PKWY STE 320 | ||||||||
| Address2: | |||||||||
| City: | SUWANEE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300241048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707715269 | ||||||||
| FaxNumber: | 7707715269 | ||||||||
| Practice Location | |||||||||
| Address1: | 2685 PEACHTREE PKWY STE 320 | ||||||||
| Address2: | |||||||||
| City: | SUWANEE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300241048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707715269 | ||||||||
| FaxNumber: | 7707715269 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 06/28/2021 | ||||||||
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| AuthorizedOfficialLastName: | VIVEK | ||||||||
| AuthorizedOfficialFirstName: | UTHAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 7707715260 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 06/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | 058235 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.