=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720952336
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVANCED VASCULAR AND VEIN, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2025
-----------------------------------------------------
Last Update Date | 11/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5315 FLYNN CROSSING DRIVE
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30005-1796
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-344-8900
-----------------------------------------------------
Fax | 678-666-5201
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1551 JANMAR RD
-----------------------------------------------------
City | SNELLVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30078-5606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-344-8900
-----------------------------------------------------
Fax | 678-666-5201
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DO
-----------------------------------------------------
Name | BRADLEY MATTHEW WHITE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 239-223-9105
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0204X
-----------------------------------------------------
Taxonomy Name | Vascular & Interventional Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------