Organization Name: | GENESIS VASCULAR OF POOLER, LLC |
NPI Number: | 1376930339 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JAMES THOMAS O'DARE (PRINCIPAL) |
Mailing Address: | 1000 Towne Center Blvd Building 400 Pooler |
State: | GA US |
Postal Code: | 313224052 |
Phone Number: | 9126620223 |
Fax Number: | 9126620224 |
NPI Enumeration Date: | 04/16/2015 |
NPI Last Update Date: | 11/13/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 207RC0000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Internal Medicine |
Taxonomy Specialization: | Cardiovascular Disease |
Taxonomy Definition: | An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |