1033662192 NPI number — ADVANCED UROLOGY ANESTHESIA, LLC

Table of content: (NPI 1033662192)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033662192 NPI number — ADVANCED UROLOGY ANESTHESIA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED UROLOGY ANESTHESIA, 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:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1033662192
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1722
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBUS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31902-1722
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-344-8900
Provider Business Mailing Address Fax Number:
678-666-5201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10730 MEDLOCK BRIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNS CREEK
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30097-1705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-344-8900
Provider Business Practice Location Address Fax Number:
678-666-5201
Provider Enumeration Date:
07/25/2016

Additional Information

Authorized Official

Authorized Official Last Name:
PATEL
Authorized Official First Name:
JITESH
Authorized Official Middle Name:
V
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
678-344-8900

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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