Organization
SOUTH ATLANTA VASCULAR INSTITUTE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID WILLIAM ALLISON MD (MANAGING MEMBER)
(770) 405-8496
Entity
Organization
Contact information
Practice address
4714 OAKLEIGH MANOR DR, POWDER SPRINGS, GA 30127-4923
(770) 688-5334
Mailing address
4714 OAKLEIGH MANOR DR, POWDER SPRINGS, GA 30127-4923
(770) 688-5334
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
70519
GA
2086S0129X
Vascular Surgery Physician
Primary
66855
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1386869535
—
TN
05
—
1598965006
—
GA
05
—
1760644355
—
MA
Enumeration date
05/24/2018
Last updated
05/24/2018
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