The Vascular Clinic LLC

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

Legal business name

THE VASCULAR CLINIC LLC

Practice address

102 Gross Crescent Cir
Suite 204
Ft Oglethorpe, GA 30742-3600

Phone

(706) 858-0204

Fax

(706) 858-0225

NPI assigned

Jun 1, 2006

Organization subpart

No

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

Authorized official

Name

Michael B Saaka

Title

Owner

Phone

(706) 858-0204

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Vascular Clinic of Northwest Georgia, LLC Former legal business name

Locations

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213142400000",
    "number": "1861439614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 GROSS CRESCENT CIR",
            "address_2": "SUITE 204",
            "city": "FT OGLETHORPE",
            "state": "GA",
            "postal_code": "307423600",
            "telephone_number": "706-858-0204",
            "fax_number": "706-858-0225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 GROSS CRESCENT CIR",
            "address_2": "SUITE 204",
            "city": "FT OGLETHORPE",
            "state": "GA",
            "postal_code": "307423600",
            "telephone_number": "706-858-0204",
            "fax_number": "706-858-0225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE VASCULAR CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-01",
        "last_updated": "2008-06-11",
        "status": "A",
        "authorized_official_last_name": "SAAKA",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-858-0204"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Vascular Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TENNESSE BLUE SHIELD",
            "identifier": "4176994",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "143447302A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3734225",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Vascular Clinic of Northwest Georgia, LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Vascular Surgery Physician in Ft Oglethorpe, GA
• Providers in Ft Oglethorpe, 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 Jun 11, 2008; 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.