ANTIOCH VASCULAR CENTER, LLC (NPI# 1023517505) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023517505 |
| Entity Type | Organization |
| Organization Name | ANTIOCH VASCULAR CENTER, LLC |
| Practice Address |
9104 Middleground Road Suite 2 Savannah GA 31406 |
| Practice Telephone | 9129278011 |
| Practice Fax Number | 9129278311 |
| Enumeration Date | 2018-02-09 |
| Last Update Date | 2018-02-09 |
| Authorized Official Name | MR. J ALPHONSO DANDY (CEO) |
| Authorized Official Telephone | 9129278011 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
Allopathic & Osteopathic Physicians | ||
| Y | 246XC2903X |
Spec/Tech, Cardiovascular Specialization: Vascular Specialist |
Technologists, Technicians & Other Technical Service Providers |
| Street Address |
9104 MIDDLEGROUND ROAD SUITE 2 |
| City | SAVANNAH |
| State | GA |
| Zip Code | 31406 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
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| 1831737949 | Sumona Mitchell | Specialist | 1100 Eisenhower Drive 15, Suite 7, Savannah, GA 31406 | 2019-12-19 |
| 1295373090 | Gateway Behavioral Health Services | Community/Behavioral Health | 2121 East Derenne Ave, Savannah, GA 31406 | 2019-12-12 |
| 1114578820 | Kenya Burns | Technician | 6 Castle Ct, Savannah, GA 31406 | 2019-09-24 |
| 1841755287 | Southside Emergency Dental Center LLC | Dentist | 10515 White Bluff Rd., Savannah, GA 31406 | 2019-02-08 |
| 1639651003 | Rachael Putman | Physical Therapist | 37 W Fairmont Ave Suite 323, Savannah, GA 31406 | 2018-09-03 |
| 1417439852 | Happy Kids Therapies, LLC | Physical Therapist | 37 W. Fairmont Avenue Suite 102, Savannah, GA 31406 | 2018-09-01 |
| 1487146619 | Georgia Occmed LLC | Clinic/Center | 310 Eisenhower Dr Bldg 12 Ste C, Savannah, GA 31406 | 2018-06-04 |
| 1518496116 | Janay C Russell | Counselor | 6711 Forest Park Drive, Savannah, GA 31406 | 2017-06-07 |
| 1619406626 | Clearwater Health Services Inc | Home Health | 5859 Abercorn Street, Suite 3, Savannah, GA 31406 | 2017-06-05 |
| Find all providers in zip 31406 | ||||
| Taxonomy Code | 246XC2903X |
| Grouping | Technologists, Technicians & Other Technical Service Providers |
| Classification | Spec/Tech, Cardiovascular |
| Specialization | Vascular Specialist |
| Definition to come... |
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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.