Provider Demographics
NPI:1881484350
Name:PREVOSTI VEIN CENTER LLC
Entity type:Organization
Organization Name:PREVOSTI VEIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:PREVOSTI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:404-556-9587
Mailing Address - Street 1:147 REINHARDT COLLEGE PKWY STE 10
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5295
Mailing Address - Country:US
Mailing Address - Phone:470-567-9047
Mailing Address - Fax:470-567-9047
Practice Address - Street 1:147 REINHARDT COLLEGE PKWY STE 10
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-5295
Practice Address - Country:US
Practice Address - Phone:470-567-9047
Practice Address - Fax:470-567-9047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-08
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty