Provider Demographics
NPI:1184873390
Name:SAVANNAH VASCULAR INSTITUTE, LLC
Entity type:Organization
Organization Name:SAVANNAH VASCULAR INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:L
Authorized Official - Last Name:WIXON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-352-8346
Mailing Address - Street 1:PO BOX 13787
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-0787
Mailing Address - Country:US
Mailing Address - Phone:912-352-8346
Mailing Address - Fax:912-355-5515
Practice Address - Street 1:4750 WATERS AVENUE
Practice Address - Street 2:SUITE 500
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6261
Practice Address - Country:US
Practice Address - Phone:912-352-8346
Practice Address - Fax:912-355-5515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-11
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA851454473BMedicaid
GA851454473CMedicaid
SCGPA975Medicaid
GA851454473AMedicaid
SCD03255Medicare PIN
GAD02175Medicare PIN
GA851454473CMedicaid
GA511G701006Medicare PIN
SCGPA975Medicaid