Provider Demographics
NPI:1104959808
Name:THE VEIN CENTER OF NORTH GEORGIA
Entity type:Organization
Organization Name:THE VEIN CENTER OF NORTH GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:TUCKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-664-5713
Mailing Address - Street 1:3400 OLD MILTON PARKWAY
Mailing Address - Street 2:SUITE C590
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005
Mailing Address - Country:US
Mailing Address - Phone:770-664-5713
Mailing Address - Fax:770-663-0080
Practice Address - Street 1:3400 OLD MILTON PKWY
Practice Address - Street 2:SUITE C590
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3707
Practice Address - Country:US
Practice Address - Phone:770-664-5713
Practice Address - Fax:770-663-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00915087BMedicaid
GAGRP7470Medicare ID - Type Unspecified
GA00915087BMedicaid