Healthcare Provider Details

I. General information

NPI: 1033662192
Provider Name (Legal Business Name): ADVANCED UROLOGY ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2016
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10730 MEDLOCK BRIDGE RD
JOHNS CREEK GA
30097-1705
US

IV. Provider business mailing address

PO BOX 1722
COLUMBUS GA
31902-1722
US

V. Phone/Fax

Practice location:
  • Phone: 678-344-8900
  • Fax: 678-666-5201
Mailing address:
  • Phone: 678-344-8900
  • Fax: 678-666-5201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JITESH V PATEL
Title or Position: PRESIDENT
Credential: MD
Phone: 678-344-8900