# NORTHEAST ATLANTA VASCULAR CARE, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1417229741
- **Authorized official:** LISA MCNAMARA (CFO)
- **Authorized official phone:** (239) 597-2010

## Contact information

- **Practice address:** 1 DUNWOODY PARK STE 130, ATLANTA, GA 30338-6714
- **Practice address phone:** (239) 597-2010
- **Practice address fax:** (239) 597-2313
- **Mailing address:** 9140 CORSEA DEL FONTANA WAY, NAPLES, FL 34109-4397
- **Mailing address phone:** (239) 597-2010
- **Mailing address fax:** (239) 597-2313

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | NULL | — |
| 2085R0204X | Vascular & Interventional Radiology Physician | — | — | — |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 02/01/2012
- **Last updated:** 09/06/2022