PREFERRED VASCULAR SERVICES NORTHWEST, LLC (NPI# 1598037822) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1598037822 |
| Entity Type | Organization |
| Organization Name | PREFERRED VASCULAR SERVICES NORTHWEST, LLC |
| Other Organization Name | PREFERRED VASCULAR SERVICES OF GEORGIA, LLC |
| Practice Address |
711 Canton Rd Ne Ste 220 Marietta GA 30060-8949 |
| Mailing Address |
9140 Coresa Del Fontana Way Naples FL 34109 |
| Practice Telephone | 4045542196 |
| Practice Fax Number | 4045542415 |
| Mailing Telephone | 2395972010 |
| Mailing Fax Number | 2395972313 |
| Enumeration Date | 2012-02-01 |
| Last Update Date | 2018-11-14 |
| Authorized Official Name | MRS. LISA A MCNAMARA (EXECUTIVE VICE PRESIDENT) |
| Authorized Official Telephone | 2395972010 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
Allopathic & Osteopathic Physicians | ||
| Y | 2086S0129X |
Surgery Specialization: Vascular Surgery |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Preferred Vascular Services of Georgia, LLC | Former Legal Business Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1100 Lake Hearn Dr Ne, Suite 200, Atlanta, GA 303421523 | 4044038310 | 8883730497 |
| 711 Canton Rd Ne Ste 220, Marietta, GA 300608949 | 4045542196 | 4045542415 |
| Street Address |
711 CANTON RD NE STE 220 |
| City | MARIETTA |
| State | GA |
| Zip Code | 30060-8949 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578644258 | John Theodore Perry IIi | Radiology | 711 Canton Rd Ne Ste 220, Marietta, GA 30060-8949 | 2006-10-18 |
| 1861766636 | Northwest Atlanta Vascular Care LLC | Radiology | 711 Canton Rd Ne Ste 220, Marietta, GA 30060-8949 | 2012-02-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144845116 | Legacy Center for Spinal Surgery, LLC | Neurological Surgery | 1900 The Exchange, Ne, Suite 600, Marietta, GA 30060 | 2020-06-15 |
| 1407477193 | Michael Cynil Daniel | Counselor | 698 N Marietta, Pkwy, Marietta, GA 30060 | 2020-05-04 |
| 1285253401 | Cameron Thomas Kennelly | Student in an Organized Health Care Education/Training Program | 677 Church Street Ne Attn:gme, Marietta, GA 30060 | 2020-04-09 |
| 1922640739 | Jeremiah George Blair | Physician Assistant | 61 Whitcher St Suite 2100, Marietta, GA 30060 | 2019-10-14 |
| 1164064945 | Denise Alicia Mick | Registered Nurse | 677 Church St Wellstar Kennestone Hospital, Marietta, GA 30060 | 2019-10-12 |
| 1184283772 | Iora Health Georgia, P.C. | Internal Medicine | 280 Cobb Pkwy Se, Suite 60, Marietta, GA 30060 | 2019-06-07 |
| 1346703212 | Caitlin Virginia Mueller | Student in an Organized Health Care Education/Training Program | 677 Church Street Ne, Attn: Gme, Marietta, GA 30060 | 2019-04-08 |
| 1184187205 | Adero Francis | Student in an Organized Health Care Education/Training Program | Wellstar Kennestone Gme Internal Medicine Clinic, 833 Campbell Hill St Nw, Suite 250, Marietta, GA 30060 | 2019-04-08 |
| 1659832749 | Matthew Mozzo | Student in an Organized Health Care Education/Training Program | 677 Church Street / Lower Level, Gme Department / I.m., Marietta, GA 30060 | 2019-03-29 |
| 1245797430 | La'myia Spentz | Specialist | 109 Anderson St Ne, Suite 608, Marietta, GA 30060 | 2019-02-25 |
| Find all providers in zip 30060 | ||||
| Taxonomy Code | 2086S0129X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Vascular Surgery |
| A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477594547 | Jeffrey Neil Winter | Surgery | 61 Whitcher St Ne Ste 2100, Marietta, GA 30060-1179 | 2006-06-09 |
| 1891788600 | Steven W. Oweida | Surgery | 61 Whitcher Street Ne, Suite 2100, Marietta, GA 30060 | 2005-08-26 |
| 1619355906 | Anand Parikh | Surgery | 61 Whitcher St Ne Ste 2100, Marietta, GA 30060-1179 | 2015-05-07 |
| 1245638998 | Atlanta Laser Vein Institute, LLC | Surgery | 1050 E Piedmont Rd, Suite 104, Marietta, GA 30062-4758 | 2014-12-11 |
| 1750678637 | Emily Lagergren | Surgery | 61 Whitcher St Ne Ste 2100, Marietta, GA 30060 | 2011-06-29 |
| 1033382122 | Michael Richard Corey | Surgery | 61 Whitcher St Ne, Suite 2100, Marietta, GA 30060-1176 | 2008-04-09 |
| 1114083532 | Vascular Surgical Associates, PC | Surgery | 61 Whitcher St Ne Ste 2100, Marietta, GA 30060-1179 | 2006-12-29 |
| 1801979992 | Steven Paul Rivers | Surgery | 400 Matthew St, Suite 208, Marietta, OH 45750-1644 | 2006-10-23 |
| 1205875739 | John E Jones | Surgery | 61 Whitcher Street Ne, Suite 2100, Marietta, GA 30060-1179 | 2006-06-06 |
| 1932176377 | Charles W Wyble Jr. | Surgery | 61 Whitcher Street Ne, Suite 2100, Marietta, GA 30060-1179 | 2006-03-03 |
| Find all providers in MARIETTA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.