Provider Demographics
NPI:1093250615
Name:ADVANCED VASCULAR INSTITUTE
Entity Type:Organization
Organization Name:ADVANCED VASCULAR INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:SYED
Authorized Official - Middle Name:ATIF
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-910-2377
Mailing Address - Street 1:5236 HAVERFORD MILL CV
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-5955
Mailing Address - Country:US
Mailing Address - Phone:770-910-2377
Mailing Address - Fax:
Practice Address - Street 1:1374 HIGHWAY 192 E
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-3123
Practice Address - Country:US
Practice Address - Phone:770-910-2377
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-05
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31393207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty