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General NPI Number Information
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NPI Number | 1093250615
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Entity Type | Organization
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Legal Business Name | ADVANCED VASCULAR INSTITUTE
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Dates
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Enumeration Date | 01/05/2017
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | 1374 HIGHWAY 192 E
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City | LONDON
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State | KY
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Zip | 40741-3123
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Country | US
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Telephone | 770-910-2377
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Fax |
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Provider Business Mailing Address
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Address Line | 5236 HAVERFORD MILL CV
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City | LILBURN
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State | GA
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Zip | 30047-5955
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Country | US
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Telephone | 770-910-2377
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MR. SYED ATIF ALI
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Credential |
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Telephone | 770-910-2377
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0011X
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Taxonomy Name | Interventional Cardiology Physician
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License Number | 31393
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License Number State | KY
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