Provider Demographics
NPI:1497364749
Name:BARIATRIC AND MINIMALLY INVASIVE SURGICAL INSTITUTE
Entity Type:Organization
Organization Name:BARIATRIC AND MINIMALLY INVASIVE SURGICAL INSTITUTE
Other - Org Name:BARIATRIC AND MINIMALLY INVASIVE SURGICAL INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIR
Authorized Official - Middle Name:H
Authorized Official - Last Name:ARYAIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-626-0909
Mailing Address - Street 1:1105 UPPER HEMBREE RD STE A
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-0912
Mailing Address - Country:US
Mailing Address - Phone:404-512-6648
Mailing Address - Fax:844-989-2029
Practice Address - Street 1:1105 UPPER HEMBREE RD STE A
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-0912
Practice Address - Country:US
Practice Address - Phone:678-626-0909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1780984658Medicaid