# GEORGIA INTERVENTIONAL AND VASCULAR SPECIALISTS, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255683470
- **Authorized official:** CYNTHIA JONES (CREDENTIALING)
- **Authorized official phone:** (630) 725-2737

## Contact information

- **Practice address:** 264 19TH ST NW STE 2240, ATLANTA, GA 30363-1139
- **Practice address phone:** (404) 532-1564
- **Practice address fax:** (404) 532-1565
- **Mailing address:** 2015 SPRING RD STE 300, OAK BROOK, IL 60523-3944
- **Mailing address phone:** (630) 725-2700

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 202K00000X | Phlebology Physician | 042261 | GA | Yes |
| 207R00000X | Internal Medicine Physician | 042261 | GA | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |

## Other

- **Enumeration date:** 10/11/2012
- **Last updated:** 02/08/2022