Provider Demographics
NPI:1437642857
Name:GEORGIA VASCULAR & VEIN CENTER
Entity Type:Organization
Organization Name:GEORGIA VASCULAR & VEIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:UTHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:VIVEK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-771-5265
Mailing Address - Street 1:2685 PEACHTREE PKWY STE 340
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-1048
Mailing Address - Country:US
Mailing Address - Phone:770-771-5268
Mailing Address - Fax:770-771-5268
Practice Address - Street 1:2685 PEACHTREE PKWY STE 340
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-1048
Practice Address - Country:US
Practice Address - Phone:770-771-5265
Practice Address - Fax:770-771-5268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-11
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical