Provider Demographics
NPI:1902273709
Name:VASCULAR INSTITUTE OF ATLANTA, LLC
Entity Type:Organization
Organization Name:VASCULAR INSTITUTE OF ATLANTA, LLC
Other - Org Name:VASCULARONE, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:AGENT/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:RICOTTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:470-355-3053
Mailing Address - Street 1:1357 HEMBREE RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-5722
Mailing Address - Country:US
Mailing Address - Phone:470-355-3053
Mailing Address - Fax:770-716-6225
Practice Address - Street 1:1357 HEMBREE RD
Practice Address - Street 2:SUITE 240
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5722
Practice Address - Country:US
Practice Address - Phone:470-355-3053
Practice Address - Fax:770-716-6225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-27
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0644522086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA148016Medicare UPIN