Active NPI
Southeast Atlanta Vascular Care, LLC
- Critical Access Hospital
- Lithonia, GA
National Provider Identifier
1912594581
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Critical Access Hospital
- Legal business name
- SOUTHEAST ATLANTA VASCULAR CARE, LLC
- Practice address
- 5461 Hillandale Dr Ste 210
Lithonia, GA 30058-4842 - Phone
- (239) 597-2010
- Fax
- (770) 981-8908
- NPI assigned
- Dec 29, 2020
- Last updated
- Dec 29, 2020
- Organization subpart
- Yes
- Parent organization
- SOUTHEAST ATLANTA VASCULAR CARE, LLC
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Lisa McNamara
- Title
- Cfo
- Phone
- (239) 597-2010
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Access Hospital | 282NC0060X | NU | Primary |
Addresses
Primary practice location
5461 Hillandale Dr Ste 210
Lithonia, GA 30058-4842
Mailing address
9140 Corsea del Fontana Way
Naples, FL 34109-4397
Phone (239) 597-2010
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1912594581. Details of each certification follow.
Hospital certification: CCN 110246
Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.
- Legal name
- SOUTHEAST ATLANTA VASCULAR CARE, LLC
- Certification status
- Terminated Voluntary: merger or closure, May 12, 2023
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Dec 3, 2020
- Last certification
- Dec 3, 2020
- Beds
- 1
- Ownership / control type
- Private (for profit)
- Facility address
- 5461 Hillandale Dr, Ste 210
Lithonia, GA 30058
National Provider Directory
National Provider Directory- Part of
- Southeast Atlanta Vascular Care LLC
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1609200000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1609200000000",
"number": "1912594581",
"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",
"telephone_number": "239-597-2010",
"fax_number": "239-597-2313"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5461 HILLANDALE DR STE 210",
"city": "LITHONIA",
"state": "GA",
"postal_code": "300584842",
"telephone_number": "239-597-2010",
"fax_number": "770-981-8908"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SOUTHEAST ATLANTA VASCULAR CARE, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "SOUTHEAST ATLANTA VASCULAR CARE, LLC",
"enumeration_date": "2020-12-29",
"last_updated": "2020-12-29",
"certification_date": "2020-12-29",
"status": "A",
"authorized_official_last_name": "MCNAMARA",
"authorized_official_first_name": "LISA",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "239-597-2010"
},
"taxonomies": [
{
"code": "282NC0060X",
"taxonomy_group": "",
"desc": "General Acute Care Hospital, Critical Access",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lithonia, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.