=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225675812
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KARE ASC, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2019
-----------------------------------------------------
Last Update Date | 12/03/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4165 OLD MILTON PKWY STE 150B
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30005-4477
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-878-4555
-----------------------------------------------------
Fax | 678-878-4556
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 600 PROFESSIONAL DR STE 160A
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30046-8717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-878-4555
-----------------------------------------------------
Fax | 678-878-4556
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | DR. AMISH TILARA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 678-878-4555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0204X
-----------------------------------------------------
Taxonomy Name | Vascular & Interventional Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------