NPIMap

Organization Active NPI

Preferred Vascular Services Northeast

  • Vascular Surgery Physician
  • Atlanta, GA
National Provider Identifier
1780184218
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 NORTHEAST
Practice address
1 Dunwoody Park Ste 140
Atlanta, GA 30338-6708
Phone
(404) 554-2080
Fax
(404) 554-8021
NPI assigned
Feb 21, 2018
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

1 Dunwoody Park Ste 140
Atlanta, GA 30338-6708

Mailing address

9140 Corsea del Fontana Way
Naples, FL 34109-4397

Other practice location 1

1100 Lake Hearn Dr Ste 200
Atlanta, GA 30342-1573
Phone (404) 554-2080

Other practice location 2

1 Dunwoody Park Ste 130
Atlanta, GA 30338-6714
Phone (404) 554-2080

Other practice location 3

3885 Princeton Lakes Way SW Ste 312
Atlanta, GA 30331-7100
Phone (404) 349-7770

Other practice location 4

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

Other practice location 5

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

Other practice location 6

711 Canton Rd NE Ste 220
Marietta, GA 30060-8949
Phone (404) 554-2196

Other practice location 7

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

Other practice location 8

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

Other practice location 9

1000 Johnson Fy Rd NE
Atlanta, GA 30342-1606
Phone (404) 554-2080

Other practice location 10

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181017002434 GA Part B Supplier - Clinic/Group Practice 3577815695 Receives reassigned benefits from 19 practitioners
Practice locations: Atlanta, GA; Lithonia, GA; Macon, GA; Marietta, GA

National Provider Directory

National Provider Directory

Member organizations 8

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

Locations

1 Dunwoody Park
#S130
Atlanta, GA 30338

1 Dunwoody Park
Ste 130140
Atlanta, GA 30338

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

711 Canton Rd NE
Ste 220
Marietta, GA 30060
Phone (404) 554-2196

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

Practitioners & affiliated clinicians

Practitioners 19

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

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1519171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770336000000",
    "number": "1780184218",
    "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": "1 DUNWOODY PARK STE 140",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303386708",
            "telephone_number": "404-554-2080",
            "fax_number": "404-554-8021"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1100 Lake Hearn Dr Ste 200",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303421573",
            "country_code": "US",
            "telephone_number": "404-554-2080",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 Dunwoody Park Ste 130",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303386714",
            "country_code": "US",
            "telephone_number": "404-554-2080",
            "fax_number": "833-471-3311",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3885 Princeton Lakes Way SW Ste 312",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303317100",
            "country_code": "US",
            "telephone_number": "404-349-7770",
            "fax_number": "833-471-3311",
            "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",
            "fax_number": "833-471-3311",
            "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",
            "fax_number": "833-471-3311",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "711 Canton Rd NE Ste 220",
            "address_purpose": "LOCATION",
            "city": "Marietta",
            "state": "GA",
            "postal_code": "300608949",
            "country_code": "US",
            "telephone_number": "404-554-2196",
            "fax_number": "833-471-3311",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5461 Hillandale Dr Ste 210B",
            "address_purpose": "LOCATION",
            "city": "Lithonia",
            "state": "GA",
            "postal_code": "300584842",
            "country_code": "US",
            "telephone_number": "770-981-8477",
            "fax_number": "833-471-3311",
            "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",
            "fax_number": "833-471-3311",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1000 Johnson Fy Rd NE",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303421606",
            "country_code": "US",
            "telephone_number": "404-554-2080",
            "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",
            "fax_number": "833-471-3311",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PREFERRED VASCULAR SERVICES NORTHEAST",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-21",
        "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": []
}

Other providers in Atlanta, 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.