=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467806083
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATLANTA VISION INSTITUTE PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2016
-----------------------------------------------------
Last Update Date | 04/20/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1841 PEACHTREE RD NE
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30309-1524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-622-2488
-----------------------------------------------------
Fax | 770-495-7789
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11459 JOHNS CREEK PKWY SUITE 100
-----------------------------------------------------
City | JOHNS CREEK
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30097-3515
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-622-2488
-----------------------------------------------------
Fax | 770-495-7789
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. M. FAROOQ ASHRAF
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 770-622-2488
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | 048590
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------