=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043174857
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED VASCULAR AND VEIN, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/15/2025
-----------------------------------------------------
Last Update Date | 12/15/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2711 IRVIN WAY STE 101
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30030-5405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-344-8900
-----------------------------------------------------
Fax | 678-666-5201
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1551 JANMAR RD
-----------------------------------------------------
City | SNELLVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30078-5606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-579-5600
-----------------------------------------------------
Fax | 678-691-0506
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | BRADLEY WHITE
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 239-223-9105
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0204X
-----------------------------------------------------
Taxonomy Name | Vascular & Interventional Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------