NPI: 1598037822
Provider Name: PREFERRED VASCULAR SERVICES NORTHWEST, LLC
Former Legal Business Name: PREFERRED VASCULAR SERVICES OF GEORGIA, LLC
Classification: Surgery - 2086S0129X
Entity Type: Organization
Specialization: Vascular Surgery
CLIA Number: 11D2198332
Address:
711 CANTON RD NE STE 220
MARIETTA, GA
ZIP 30060
Phone: (404) 554-2196
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PREFERRED VASCULAR SERVICES NORTHWEST, LLC is a vascular surgery surgery in Marietta, GA. The provider is a surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. PREFERRED VASCULAR SERVICES NORTHWEST, LLC NPI is 1598037822. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Former Legal Business Name Is Preferred Vascular Services Of Georgia, Llc.
The provider's business location address is:
711 CANTON RD NE STE 220
MARIETTA, GA
ZIP 30060-949
Phone: (404) 554-2196
Fax: (404) 554-2415
The provider's authorized official is Lisa A Mcnamara .
The authorized official title is Cfo and has the following contact phone number (239) 597-2010.
The CLIA number assigned to this NPI record is 11D2198332 - physician office with a certificate type of Certificate of Waiver.
The enumeration date for this NPI number is 2/1/2012 and was last updated on 9/6/2022.