Provider Demographics
NPI:1962949123
Name:GEORGIA VASCULAR & INTERVENTIONAL, LLC
Entity type:Organization
Organization Name:GEORGIA VASCULAR & INTERVENTIONAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHIREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-902-4847
Mailing Address - Street 1:528 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4212
Mailing Address - Country:US
Mailing Address - Phone:678-902-4847
Mailing Address - Fax:770-415-1447
Practice Address - Street 1:528 S 8TH ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224-4212
Practice Address - Country:US
Practice Address - Phone:678-902-4847
Practice Address - Fax:770-415-1447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-26
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0478422085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty