Provider Demographics
NPI:1295256311
Name:CENTER FOR VASCULAR INTERVENTION LLC
Entity type:Organization
Organization Name:CENTER FOR VASCULAR INTERVENTION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:REDD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-538-1772
Mailing Address - Street 1:5505 PEACHTREE DUNWOODY RD STE 370
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1713
Mailing Address - Country:US
Mailing Address - Phone:770-538-1772
Mailing Address - Fax:770-538-1773
Practice Address - Street 1:5505 PEACHTREE DUNWOODY RD STE 370
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1713
Practice Address - Country:US
Practice Address - Phone:770-538-1772
Practice Address - Fax:770-538-1773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-28
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1295256311OtherGROUP NPI
GA4551596OtherAETNA/COVENTRY