NPIMap

Organization Active NPI

Preferred Vascular Services Southwest

  • Vascular Surgery Physician
  • Atlanta, GA
National Provider Identifier
1790285229
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 SOUTHWEST
Practice address
3885 Princeton Lakes Way SW Ste 314
Atlanta, GA 30331-7100
Phone
(404) 349-7770
Fax
(404) 349-7778
NPI assigned
Feb 21, 2018
Last updated
Feb 6, 2026By the provider in NPPES
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

3885 Princeton Lakes Way SW Ste 314
Atlanta, GA 30331-7100

Mailing address

9140 Corsea del Fontana Way
Naples, FL 34109-4397

Other practice location 1

11 Upper Riverdale Rd SW
Riverdale, GA 30274-2615
Phone (404) 349-7770

Other practice location 2

5835 Campbellton Rd SW Ste 104
Atlanta, GA 30331-8014
Phone (404) 349-7770

Other practice location 3

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181010003246 GA Part B Supplier - Clinic/Group Practice 0446502918 Receives reassigned benefits from 19 practitioners
Practice locations: Atlanta, GA; Riverdale, GA

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D2198332Preferred Vascular Services Southwest, LLC3885 Princeton Lakes Way SW Suite 312B, Atlanta, GA 30331Certificate of waiverNov 1, 2026

National Provider Directory

National Provider Directory

Member of 1

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

Locations

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

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

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

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": "1790285229",
    "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": "3885 PRINCETON LAKES WAY SW STE 314",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303317100",
            "telephone_number": "404-349-7770",
            "fax_number": "404-349-7778"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11 Upper Riverdale Rd SW",
            "address_purpose": "LOCATION",
            "city": "Riverdale",
            "state": "GA",
            "postal_code": "302742615",
            "country_code": "US",
            "telephone_number": "404-349-7770",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5835 Campbellton Rd SW Ste 104",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303318014",
            "country_code": "US",
            "telephone_number": "404-349-7770",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3885 Princeton Lakes Way SW Ste 312B",
            "address_purpose": "LOCATION",
            "city": "Atlanta",
            "state": "GA",
            "postal_code": "303317100",
            "country_code": "US",
            "telephone_number": "404-349-7770",
            "fax_number": "404-349-7778",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PREFERRED VASCULAR SERVICES SOUTHWEST",
        "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.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.