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General NPI Number Information
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NPI Number | 1144742271
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Entity Type | Organization
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Legal Business Name | ATLANTA VASCULAR AND INTERVENTIONAL RADIOLOGY ASSOCIATE, LLC
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Dates
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Enumeration Date | 07/11/2017
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Last Update Date | 07/11/2017
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Provider Practice Location Address
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Address Line | 4550 JONESBORO RD STE K
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City | UNION CITY
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State | GA
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Zip | 30291-2053
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Country | US
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Telephone | 678-519-0334
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Fax | 404-920-3430
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Provider Business Mailing Address
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Address Line | 3645 MARKETPLACE BLVD STE 130-420
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City | EAST POINT
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State | GA
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Zip | 30344-5747
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Country | US
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Telephone | 678-519-0334
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Fax | 404-920-3430
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ANISHUA M ROBERTS
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Credential |
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Telephone | 678-519-0344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State | GA
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