Provider Demographics
NPI:1881035061
Name:ADVANCED VASCULAR RESOURCES OF ATLANTA LLC
Entity Type:Organization
Organization Name:ADVANCED VASCULAR RESOURCES OF ATLANTA LLC
Other - Org Name:AVR OF ATLANTA
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MOBUSHER
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMUD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-994-6655
Mailing Address - Street 1:20032 NORTHVILLE HILLS TER
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-7020
Mailing Address - Country:US
Mailing Address - Phone:703-994-6655
Mailing Address - Fax:571-291-2752
Practice Address - Street 1:1938 PEACHTREE RD NW
Practice Address - Street 2:SUITE L5
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1267
Practice Address - Country:US
Practice Address - Phone:678-831-2722
Practice Address - Fax:678-999-5055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-16
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty