# PREFERRED VASCULAR SERVICES NORTHWEST, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Preferred Vascular Services of Georgia, LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598037822
- **Authorized official:** JENNIFER BOYD BALDOCK (OFFICER AND AUTHORIZED OFFICIAL)
- **Authorized official phone:** (615) 234-5954

## Contact information

- **Practice address:** 711 CANTON RD NE STE 220, MARIETTA, GA 30060-8949
- **Practice address phone:** (404) 554-2196
- **Practice address fax:** (404) 597-2313
- **Mailing address:** 9140 CORSEA DEL FONTANA WAY, NAPLES, FL 34109-4397

## 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:** 02/06/2026