1144742271 NPI number — ATLANTA VASCULAR AND INTERVENTIONAL RADIOLOGY ASSOCIATE, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144742271 NPI number — ATLANTA VASCULAR AND INTERVENTIONAL RADIOLOGY ASSOCIATE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ATLANTA VASCULAR AND INTERVENTIONAL RADIOLOGY ASSOCIATE, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144742271
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3645 MARKETPLACE BLVD STE 130-420
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAST POINT
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30344-5747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-519-0334
Provider Business Mailing Address Fax Number:
404-920-3430

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4550 JONESBORO RD STE K
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION CITY
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30291-2053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-519-0334
Provider Business Practice Location Address Fax Number:
404-920-3430
Provider Enumeration Date:
07/11/2017

Additional Information

Authorized Official

Authorized Official Last Name:
ROBERTS
Authorized Official First Name:
ANISHUA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
678-519-0344

Provider Taxonomy Codes

  • Taxonomy code: 2085R0204X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com