Southern Vascular Specialists LLC

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

055328 Issued in GA

Legal business name

SOUTHERN VASCULAR SPECIALISTS LLC

Practice address

505 Gordon Ave
Thomasville, GA 31792-6645

Phone

(229) 224-4858

NPI assigned

Oct 25, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Albert Isaac Richardson II, M.D.NPI 1558469981

Title

Owner

Phone

(229) 224-4858

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Tax ID family

Southern Vascular Speciaists2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Southern Vascular Speciaists

  • Specialist
  • Thomasville, GA
  • NPI 1770032831
  NPD tax ID

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Albert I Richardson II, M.D.

  • Vascular Surgery Physician
  • Thomasville, GA
  • NPI 1558469981
  Medicare reassignment Care Compare group NPD Authorized official
• Karen Burke Lee, NP

  • Family Nurse Practitioner
  • Thomasville, GA
  • NPI 1730521022
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1477353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1477353600000",
    "number": "1194277210",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6010",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317586010",
            "telephone_number": "229-224-4858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 GORDON AVE",
            "city": "THOMASVILLE",
            "state": "GA",
            "postal_code": "317926645",
            "telephone_number": "229-224-4858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN VASCULAR SPECIALISTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-25",
        "last_updated": "2016-10-25",
        "status": "A",
        "authorized_official_last_name": "RICHARDSON",
        "authorized_official_first_name": "ALBERT",
        "authorized_official_middle_name": "ISAAC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "229-224-4858",
        "authorized_official_name_suffix": "II",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": "GA",
            "license": "055328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Southern Interventional Pain Center LLC
• Southern Psychological Services
• Southern Scripts, LLC
• Southern Sleep Services
• Southern Vascular Speciaists
• Southland Emergency Medical Services, L.L.C
• Southland Hospitalist Group, LLC
• Southwestern State Hospital
• Southwestern State Hospital
• Southwestern State Hospital

• Vascular Surgery Physician in Thomasville, GA
• Providers in Thomasville, GA by specialty
• Vascular Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.