Provider Demographics
NPI:1992839294
Name:VASCULAR AND INTERVENTIONAL RADIOLOGY ASSOCIATES OF CENTRAL GA
Entity Type:Organization
Organization Name:VASCULAR AND INTERVENTIONAL RADIOLOGY ASSOCIATES OF CENTRAL GA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:HAMILTON
Authorized Official - Last Name:MCCAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-757-8868
Mailing Address - Street 1:6501 PEAKE ROAD
Mailing Address - Street 2:BLDG 900
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210
Mailing Address - Country:US
Mailing Address - Phone:478-757-8868
Mailing Address - Fax:478-471-1221
Practice Address - Street 1:6501 PEAKE ROAD
Practice Address - Street 2:BLDG 900
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210
Practice Address - Country:US
Practice Address - Phone:478-757-8868
Practice Address - Fax:478-471-1221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0217442085R0204X
GA199152085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAC14011Medicare UPIN
GAD46052Medicare UPIN
GAGRP3771Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER