Provider Demographics
NPI:1861647414
Name:ENDOVASCULAR THERAPY AND VASCULAR SURGERY OF GA
Entity Type:Organization
Organization Name:ENDOVASCULAR THERAPY AND VASCULAR SURGERY OF GA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARIGNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-267-1040
Mailing Address - Street 1:4450 CALIBRE CROSSING SUITE 1122
Mailing Address - Street 2:GOVERNORS PAVILION BLDG
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-0000
Mailing Address - Country:US
Mailing Address - Phone:850-267-1040
Mailing Address - Fax:866-799-9384
Practice Address - Street 1:4450 CALIBRE CROSSING SUITE 1122
Practice Address - Street 2:GOVERNORS PAVILION BLDG
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-0000
Practice Address - Country:US
Practice Address - Phone:850-267-1040
Practice Address - Fax:866-799-9384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-24
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty