Healthcare Provider Details

I. General information

NPI: 1497364749
Provider Name (Legal Business Name): BARIATRIC AND MINIMALLY INVASIVE SURGICAL INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2020
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1105 UPPER HEMBREE RD STE A
ROSWELL GA
30076-0912
US

IV. Provider business mailing address

1105 UPPER HEMBREE RD STE A
ROSWELL GA
30076-0912
US

V. Phone/Fax

Practice location:
  • Phone: 678-626-0909
  • Fax:
Mailing address:
  • Phone: 404-512-6648
  • Fax: 844-989-2029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AMIR H ARYAIE
Title or Position: CEO
Credential: MD
Phone: 678-626-0909