# SOUTHEAST ATLANTA VASCULAR CARE, LLC

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

## Provider details

- **NPI number:** 1922549237
- **Authorized official:** LISA MCNAMARA (EVP)
- **Authorized official phone:** (239) 597-2010

## Contact information

- **Practice address:** 5461 HILLANDALE DR, SUITE 210, LITHONIA, GA 30058-4841
- **Practice address phone:** (770) 981-8477
- **Practice address fax:** (770) 981-8908
- **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:** 03/20/2017
- **Last updated:** 03/20/2017