Provider Demographics
NPI:1922169846
Name:COMPREHENSIVE VASCULAR CARE, LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE VASCULAR CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:NEIL
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:706-259-3336
Mailing Address - Street 1:1109 BURLEYSON RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-3094
Mailing Address - Country:US
Mailing Address - Phone:706-259-3336
Mailing Address - Fax:706-370-7715
Practice Address - Street 1:1109 BURLEYSON RD
Practice Address - Street 2:SUITE 202
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3094
Practice Address - Country:US
Practice Address - Phone:706-259-3336
Practice Address - Fax:706-370-7715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0473292086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA047329OtherSTATE LICENSE ID
GARN123324OtherSHULER STATE LICENSE
GA047329OtherSTATE LICENSE ID
GAQ19228Medicare UPIN
GA047329OtherSTATE LICENSE ID
GA50BBHPKMedicare ID - Type UnspecifiedSHULER MCR ID
GA77BBBKRMedicare ID - Type UnspecifiedMEDICARE PROVIDER #