Provider Demographics
NPI:1639766207
Name:SOUTHWEST ATLANTA VASCULAR CARE, LLC
Entity type:Organization
Organization Name:SOUTHWEST ATLANTA VASCULAR CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCNAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-597-2010
Mailing Address - Street 1:9140 CORSEA DEL FONTANA WAY
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-4397
Mailing Address - Country:US
Mailing Address - Phone:239-597-2010
Mailing Address - Fax:239-597-2313
Practice Address - Street 1:3885 PRINCETON LAKES WAY SW STE 314
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-7100
Practice Address - Country:US
Practice Address - Phone:404-349-7770
Practice Address - Fax:404-349-7778
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST ATLANTA VASCULAR CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access