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Organization Active NPI

Preferred Vascular Services Northwest, LLC

  • Vascular Surgery Physician
  • Marietta, GA
National Provider Identifier
1598037822
Registry record updated Feb 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Vascular Surgery PhysicianTaxonomy code 2086S0129X
Legal business name
PREFERRED VASCULAR SERVICES NORTHWEST, LLC
Practice address
711 Canton Rd NE Ste 220
Marietta, GA 30060-8949
Phone
(404) 554-2196
Fax
(404) 597-2313
NPI assigned
Feb 1, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 6, 2026

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

Authorized official

Name
Jennifer Boyd Baldock
Title
Officer and Authorized Official
Phone
(615) 234-5954

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Vascular & Interventional Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0204X
Vascular Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2086S0129X Primary

Addresses

Primary practice location

711 Canton Rd NE Ste 220
Marietta, GA 30060-8949

Mailing address

9140 Corsea del Fontana Way
Naples, FL 34109-4397

Other practice location 1

601 S 8th St
Griffin, GA 30224-4213
Phone (404) 554-2196

Other practice location 2

5461 Hillandale Dr Ste 210
Lithonia, GA 30058-4842
Phone (770) 981-8477

Other practice location 3

3885 Princeton Lakes Way SW Ste 314
Atlanta, GA 30331-7100
Phone (404) 349-7770

Other practice location 4

889 2nd St
Macon, GA 31201-6862
Phone (478) 254-9363

Other practice location 5

960 Joe Frank Harris Pkwy SE
Cartersville, GA 30120-2129
Phone (404) 554-2196

Other practice location 6

711 Canton Rd NE Ste 230
Marietta, GA 30060-8949
Phone (404) 554-2196

Other names 1

  • Preferred Vascular Services of Georgia, LLC Former legal business name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120413000013 GA Part B Supplier - Clinic/Group Practice 1850552142 Receives reassigned benefits from 20 practitioners
Practice locations: Lithonia, GA; Marietta, GA; Macon, GA; Griffin, GA; Cartersville, GA; Atlanta, GA

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

1 Dunwoody Park
Dunwoody, GA 30338
Phone (470) 702-9400

1 Dunwoody Park
Ste 130
Dunwoody, GA 30338
Phone (404) 554-2080

5461 Hillandale Dr
Lithonia, GA 30058
Phone (470) 361-2976

711 Canton Rd NE
Ste 220230
Marietta, GA 30060

790 Church St NE
Ste 510
Marietta, GA 30060
Phone (404) 403-8310

1100 Lake Hearn Dr
Ste 200
Sandy Springs, GA 30342
Phone (404) 403-8310

23600 Commerce Park
#8
Beachwood, OH 44122
Phone (404) 403-8310

23600 Commerce Park
Beachwood, OH 44122

6503 E Broad St
Columbus, OH 43213
Phone (614) 355-8160

Practitioners & affiliated clinicians

Practitioners 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1328054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770336000000",
    "number": "1598037822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9140 CORSEA DEL FONTANA WAY",
            "city": "NAPLES",
            "state": "FL",
            "postal_code": "341094397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 CANTON RD NE STE 220",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300608949",
            "telephone_number": "404-554-2196",
            "fax_number": "404-597-2313"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 S 8th St",
            "address_purpose": "LOCATION",
            "city": "Griffin",
            "state": "GA",
            "postal_code": "302244213",
            "country_code": "US",
            "telephone_number": "404-554-2196",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5461 Hillandale Dr Ste 210",
            "address_purpose": "LOCATION",
            "city": "Lithonia",
            "state": "GA",
            "postal_code": "300584842",
            "country_code": "US",
            "telephone_number": "770-981-8477",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3885 Princeton Lakes Way SW Ste 314",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303317100",
            "country_code": "US",
            "telephone_number": "404-349-7770",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "889 2nd St",
            "address_purpose": "LOCATION",
            "city": "Macon",
            "state": "GA",
            "postal_code": "312016862",
            "country_code": "US",
            "telephone_number": "478-254-9363",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "960 Joe Frank Harris Pkwy SE",
            "address_purpose": "LOCATION",
            "city": "Cartersville",
            "state": "GA",
            "postal_code": "301202129",
            "country_code": "US",
            "telephone_number": "404-554-2196",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "711 Canton Rd NE Ste 230",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "300608949",
            "country_code": "US",
            "telephone_number": "404-554-2196",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PREFERRED VASCULAR SERVICES NORTHWEST, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-01",
        "last_updated": "2026-02-06",
        "certification_date": "2026-02-06",
        "status": "A",
        "authorized_official_last_name": "BALDOCK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "BOYD",
        "authorized_official_title_or_position": "OFFICER AND AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "615-234-5954"
    },
    "taxonomies": [
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Preferred Vascular Services of Georgia, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2026; 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.