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General NPI Number Information
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NPI Number | 1407151772
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Entity Type | Organization
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Legal Business Name | ADVANCE LAPAROSCOPIC SURGERY INSTITUTE, INC.
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Dates
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Enumeration Date | 01/18/2011
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Last Update Date | 03/11/2011
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Provider Practice Location Address
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Address Line | 3890 JOHNS CREEK PKWY SUITE 240
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City | SUWANEE
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State | GA
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Zip | 30024-1284
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Country | US
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Telephone | 678-333-3584
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Fax | 678-668-7965
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Provider Business Mailing Address
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Address Line | PO BOX 62600 DEPT. 1867
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City | NEW ORLEANS
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State | LA
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Zip | 70162-2600
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Country | US
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Telephone | 678-333-3584
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Fax | 678-668-7965
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Authorized Official
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Title or Position | OWNER
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Name | DR. AHAD M KHAN
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Credential | M.D.
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Telephone | 678-333-3584
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 055763
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License Number State | GA
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