Provider Demographics
NPI:1346366747
Name:P & J ENTERPRISES OF WEST ATL, INC.
Entity Type:Organization
Organization Name:P & J ENTERPRISES OF WEST ATL, INC.
Other - Org Name:NATIONAL VASCULAR CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HUAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-424-2211
Mailing Address - Street 1:114 CHERRY ST NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-7277
Mailing Address - Country:US
Mailing Address - Phone:770-424-2211
Mailing Address - Fax:770-424-5010
Practice Address - Street 1:114 CHERRY ST NE
Practice Address - Street 2:SUITE C
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-7277
Practice Address - Country:US
Practice Address - Phone:770-424-2211
Practice Address - Fax:770-424-5010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034278261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1095130001Medicare NSC
GA2516Medicare ID - Type UnspecifiedPROVIDER NUMBER