International Vein Institute, LLC

Primary specialty

Phlebology PhysicianTaxonomy code 202K00000X

License

47638 Issued in GA

Legal business name

INTERNATIONAL VEIN INSTITUTE, LLC

Practice address

2701 US Highway 17
Richmond Hill, GA 31324-3799

Phone

(912) 756-3005

Fax

(912) 756-5921

NPI assigned

Oct 8, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Amy Adams Pearson, MD

Title

Member

Phone

(912) 756-3005

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1318032000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318032000000",
    "number": "1700160793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 US HIGHWAY 17",
            "city": "RICHMOND HILL",
            "state": "GA",
            "postal_code": "313243799",
            "telephone_number": "912-756-3005",
            "fax_number": "912-756-5921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 US HIGHWAY 17",
            "city": "RICHMOND HILL",
            "state": "GA",
            "postal_code": "313243799",
            "telephone_number": "912-756-3005",
            "fax_number": "912-756-5921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNATIONAL VEIN INSTITUTE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-08",
        "last_updated": "2011-10-08",
        "status": "A",
        "authorized_official_last_name": "PEARSON",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "ADAMS",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "912-756-3005",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "202K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Phlebology",
            "state": "GA",
            "license": "47638",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1447249289",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000831971K",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.