Provider Demographics
NPI:1043773161
Name:EFFINGHAM VASCULAR CENTER, LLC
Entity Type:Organization
Organization Name:EFFINGHAM VASCULAR CENTER, LLC
Other - Org Name:EFFINGHAM VASCULAR CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER-WITT
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MBA, LNHA
Authorized Official - Phone:912-754-0160
Mailing Address - Street 1:459 HIGHWAY 119 SOUTH
Mailing Address - Street 2:ATTN.: CREDENTIALING
Mailing Address - City:SPRINGFIELD
Mailing Address - State:GA
Mailing Address - Zip Code:31329
Mailing Address - Country:US
Mailing Address - Phone:912-754-0175
Mailing Address - Fax:912-754-2570
Practice Address - Street 1:613 TOWNE PARK DR W STE 204
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5183
Practice Address - Country:US
Practice Address - Phone:912-826-6771
Practice Address - Fax:912-295-5605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-08
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty