Provider Demographics
NPI:1295009637
Name:ALBANY VASCULAR SPECIALTIST CENTER, LLC
Entity type:Organization
Organization Name:ALBANY VASCULAR SPECIALTIST CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:H
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:229-436-8535
Mailing Address - Street 1:PO BOX 71804
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31708-1804
Mailing Address - Country:US
Mailing Address - Phone:229-436-8535
Mailing Address - Fax:229-432-1904
Practice Address - Street 1:128 WEST BROAD AVENUE
Practice Address - Street 2:
Practice Address - City:DOERUN
Practice Address - State:GA
Practice Address - Zip Code:31744
Practice Address - Country:US
Practice Address - Phone:229-782-5227
Practice Address - Fax:229-782-5228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty