Provider Demographics
NPI:1073207007
Name:GEORGIA ENDOVASCULAR ASSOCIATES, LLC
Entity Type:Organization
Organization Name:GEORGIA ENDOVASCULAR ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:THORNE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:321-228-6442
Mailing Address - Street 1:3100 INTERSTATE NORTH CIR SE STE 200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-2384
Mailing Address - Country:US
Mailing Address - Phone:713-575-3686
Mailing Address - Fax:713-575-3688
Practice Address - Street 1:3225 CUMBERLAND BLVD SE STE 520
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-6407
Practice Address - Country:US
Practice Address - Phone:713-575-3686
Practice Address - Fax:713-575-3688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-05
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty