Provider Demographics
NPI:1174506539
Name:ATHENS THORACIC & VASCULAR SURGERY, PC
Entity Type:Organization
Organization Name:ATHENS THORACIC & VASCULAR SURGERY, PC
Other - Org Name:ATHENS CARDIOVASCULAR & THORACIC SURGERY ASSOC, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAFFEI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-208-1144
Mailing Address - Street 1:784 PRINCE AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-5902
Mailing Address - Country:US
Mailing Address - Phone:706-208-1144
Mailing Address - Fax:706-208-9668
Practice Address - Street 1:784 PRINCE AVE
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-5902
Practice Address - Country:US
Practice Address - Phone:706-208-1144
Practice Address - Fax:706-208-9668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-21
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA55002007AMedicaid
GA55002007AMedicaid