Healthcare Provider Details

I. General information

NPI: 1518782374
Provider Name (Legal Business Name): VELO MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 GWINNETT DRIVE
LAWRENCEVILLE GA
30046
US

IV. Provider business mailing address

301 GWINNETT DR SW, LAWRENCEVILLE, GA 30046
LAWRENCEVILLE GA
30046-5669
US

V. Phone/Fax

Practice location:
  • Phone: 770-910-9196
  • Fax: 770-910-9197
Mailing address:
  • Phone: 770-910-9196
  • Fax: 770-910-9197

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AFIYAH HASHMI
Title or Position: CREDENTIALING DIRECTOR
Credential:
Phone: 770-910-9196