Provider Demographics
NPI:1447415393
Name:VASCULAR ACCESS CENTER OF WARNER ROBINS LLC
Entity type:Organization
Organization Name:VASCULAR ACCESS CENTER OF WARNER ROBINS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:MCGUCKIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:215-382-3680
Mailing Address - Street 1:PO BOX 38574
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-8574
Mailing Address - Country:US
Mailing Address - Phone:215-382-3680
Mailing Address - Fax:215-382-3683
Practice Address - Street 1:516 S HOUSTON LAKE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-6308
Practice Address - Country:US
Practice Address - Phone:478-225-4480
Practice Address - Fax:478-225-4481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2009-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0613012085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty