Basic Information
| Provider Information | |||||||||
| NPI: | 1881035061 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED VASCULAR RESOURCES OF ATLANTA LLC | ||||||||
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| OtherOrganizationName: | AVR OF ATLANTA | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20032 NORTHVILLE HILLS TER | ||||||||
| Address2: | |||||||||
| City: | ASHBURN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201477020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039946655 | ||||||||
| FaxNumber: | 5712912752 | ||||||||
| Practice Location | |||||||||
| Address1: | 1938 PEACHTREE RD NW | ||||||||
| Address2: | SUITE L5 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303091267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6788312722 | ||||||||
| FaxNumber: | 6789995055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2013 | ||||||||
| LastUpdateDate: | 10/23/2013 | ||||||||
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| AuthorizedOfficialLastName: | MAHMUD | ||||||||
| AuthorizedOfficialFirstName: | MOBUSHER | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7039946655 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207UN0901X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology | 2085R0204X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 208G00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 207RI0011X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology |
No ID Information.