Provider Demographics
NPI:1598262016
Name:ADVANCED UROLOGY INSTITUTE OF GEORGIA
Entity Type:Organization
Organization Name:ADVANCED UROLOGY INSTITUTE OF GEORGIA
Other - Org Name:ADVANCED UROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JITESH
Authorized Official - Middle Name:VINOD
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-751-3274
Mailing Address - Street 1:1557 JANMAR RD
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5686
Mailing Address - Country:US
Mailing Address - Phone:678-344-8900
Mailing Address - Fax:404-492-7021
Practice Address - Street 1:11660 ALPHARETTA HWY STE 700
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4956
Practice Address - Country:US
Practice Address - Phone:678-344-8900
Practice Address - Fax:404-492-7021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-11
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site