GENESIS VASCULAR OF POOLER, LLC (NPI# 1376930339) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376930339 |
| Entity Type | Organization |
| Organization Name | GENESIS VASCULAR OF POOLER, LLC |
| Other Organization Name | GV OF POOLER |
| Practice Address |
1000 Towne Center Blvd Building 400 Pooler GA 31322-4052 |
| Mailing Address |
575 N Route 73 Ste A6 West Berlin NJ 08091-9289 |
| Practice Telephone | 9126620223 |
| Practice Fax Number | 9126620224 |
| Mailing Telephone | 8563355025 |
| Mailing Fax Number | 8562139269 |
| Enumeration Date | 2015-04-16 |
| Last Update Date | 2015-11-13 |
| Authorized Official Name | JAMES THOMAS O'DARE III (PRINCIPAL) |
| Authorized Official Telephone | 8563355025 |
| Is Organization Subpart | Y |
| Parent Organization Name | GENESIS GLOBAL HEALTHCARE |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
Allopathic & Osteopathic Physicians | ||
| N | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
Allopathic & Osteopathic Physicians | ||
| N | 2086S0129X |
Surgery Specialization: Vascular Surgery |
Allopathic & Osteopathic Physicians | ||
| Y | 207RI0011X |
Internal Medicine Specialization: Interventional Cardiology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| GV of Pooler | Other Name - Individual/Organization |
| Street Address |
1000 TOWNE CENTER BLVD BUILDING 400 |
| City | POOLER |
| State | GA |
| Zip Code | 31322-4052 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154319408 | Wound Care Clinic - Esu, Inc. | Clinic/Center | 1000 Towne Center Blvd, Suite 705, Pooler, GA 31322-4052 | 2005-10-11 |
| 1891241360 | The Whole Tooth | Dentist | 1000 Towne Center Blvd, Suite 505, Pooler, GA 31322-4052 | 2016-08-25 |
| 1467815472 | Genesis Wound Care of Pooler, LLC | Durable Medical Equipment & Medical Supplies | 1000 Towne Center Blvd, Building 400, Pooler, GA 31322-4052 | 2016-03-29 |
| 1538529631 | Southern Allergy & Asthma, PC | Allergy & Immunology | 1000 Towne Center Blvd, Building 500 Suite 305, Pooler, GA 31322-4052 | 2016-03-02 |
| 1912365495 | Jana Alisa Bevill | Nurse Practitioner | 1000 Towne Center Blvd, Suite 160, Pooler, GA 31322-4052 | 2016-01-29 |
| 1598157364 | Matthew J. Allen, D.d.s., L.L.C. | Dentist | 1000 Towne Center Blvd, Suite 101, Pooler, GA 31322-4052 | 2015-03-03 |
| 1316338494 | Ear, Nose & Throat Associates of Savannah, PC | Otolaryngology | 1000 Towne Center Blvd, Ste 200, Pooler, GA 31322-4052 | 2015-02-11 |
| 1598153900 | Chatham Orthopaedic Associates, Pa | Orthopaedic Surgery | 1000 Towne Center Blvd, Suite 602, Pooler, GA 31322-4052 | 2015-01-07 |
| 1962836106 | Catherine E Hamlin | Dentist | 1000 Towne Center Blvd, Pooler, GA 31322-4052 | 2013-08-23 |
| 1508119207 | Georgia Eye Institute of The Southeast, LLC | Optometrist | 1000 Towne Center Blvd, Pooler, GA 31322-4052 | 2012-10-18 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427518745 | Quinate Pharmacy LLC | Pharmacy | 1557 Pooler Pkwy, Suite 400, Pooler, GA 31322 | 2019-03-22 |
| 1396202495 | Rucker Holdings | Durable Medical Equipment & Medical Supplies | 210 Grand Central Blvd, Pooler, GA 31322 | 2019-02-25 |
| 1306301841 | Altamaha Dme, Inc | Durable Medical Equipment & Medical Supplies | 1557 Pooler Parkway, Suite 300, Pooler, GA 31322 | 2019-02-08 |
| 1750859351 | Bombery Chiropractic LLC | Chiropractor | 122 Canal St. Ste 109, Pooler, GA 31322 | 2018-11-13 |
| 1407347891 | Georgia Dental Professionals, PC | Dentist | 2140 Pooler Pkwy, Pooler, GA 31322 | 2018-05-22 |
| 1730685439 | Monali Patel | Optometrist | 276 Pooler Pkwy Ste B, Pooler, GA 31322 | 2018-04-02 |
| 1144747023 | Publix Super Markers, Inc | Durable Medical Equipment & Medical Supplies | 101 Blue Moon Crossing, Pooler, GA 31322 | 2017-08-23 |
| 1063932408 | The Range Physical Therapy, LLC | Clinic/Center | 10801 County Line Rd, Madison, AL 31322 | 2017-06-27 |
| 1285154427 | Pooler Physical Therapy LLC | Clinic/Center | 101 Shepherd Way, Pooler, GA 31322 | 2017-06-20 |
| 1578009130 | Georgia Cvs Pharmacy L.l.c | Durable Medical Equipment & Medical Supplies | 500 Pooler Pkwy, Pooler, GA 31322 | 2017-01-06 |
| Find all providers in zip 31322 | ||||
| Taxonomy Code | 207RI0011X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Interventional Cardiology |
| An area of medicine within the subspecialty of cardiology, which uses specialized imaging and other diagnostic techniques to evaluate blood flow and pressure in the coronary arteries and chambers of the heart and uses technical procedures and medications to treat abnormalities that impair the function of the cardiovascular system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/ Board Certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. ACGME Accredited Residency Program Requirements: 1 year of training plus a prerequisite of 3 years Internal Medicine, 3 years Cardiovascular Disease for a total of 7 years. ABMS Approved Subspecialty Certificate (Internal Medicine) |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669019394 | Champ Vascular, LLC | Internal Medicine | 1825 Highway 34 E Ste 3400, Newnan, GA 30265-6423 | 2019-12-02 |
| 1174006159 | Kendall M Griffith Md LLC | Internal Medicine | 1497 Fair Rd Ste 311, Statesboro, GA 30458-0828 | 2018-09-14 |
| 1558869826 | Coordinated Health of Ga, LLC | Internal Medicine | 10 Glenlake Pkwy Ste 130c, Atlanta, GA 30328-3495 | 2018-01-31 |
| 1447559604 | David Brendan Casey | Internal Medicine | 1700 Tree Ln Ste 100, Snellville, GA 30078-6749 | 2011-03-26 |
| 1730404120 | Deepali Nivas Tukaye | Internal Medicine | 1505 Northside Blvd Ste 3400, Cumming, GA 30041-8223 | 2010-03-29 |
| 1659560647 | Oduwole Organization Inc | Internal Medicine | 1415 Highway 85 N Ste 310-296, Fayetteville, GA 30214-7738 | 2007-10-16 |
| 1053487462 | Tiftarea Cardiology | Internal Medicine | 907 E. 18th St, Ste 100, Tifton, GA 31794 | 2006-11-28 |
| 1255412094 | Jeetendra B Patel | Internal Medicine | 1301 Sigman Rd Ne Ste 200, Conyers, GA 30012 | 2006-10-18 |
| 1811082605 | Cardiac Disease Specialists, PC | Internal Medicine | 296 Merchants Sq, Dallas, GA 30132-5029 | 2006-10-04 |
| 1770508756 | Hunt Dandridge Anderson | Internal Medicine | 4500 Hospital Blvd, Suite 230, Roswell, GA 30076-0003 | 2006-07-12 |
| Find all providers with the same taxonomy | ||||
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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.