Provider Demographics
NPI:1982225959
Name:ADVANCED UROLOGY INSTITUTE OF GEORGIA, PC
Entity Type:Organization
Organization Name:ADVANCED UROLOGY INSTITUTE OF GEORGIA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JITESH
Authorized Official - Middle Name:VINOD
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-344-8900
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:678-344-8900
Practice Address - Street 1:2695 OLD WINDER HWY STE 150
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-6076
Practice Address - Country:US
Practice Address - Phone:678-344-8900
Practice Address - Fax:678-666-5201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty