Provider Demographics
NPI:1669888657
Name:AVILYS, LLC
Entity type:Organization
Organization Name:AVILYS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:SHANE
Authorized Official - Last Name:MOBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-228-4597
Mailing Address - Street 1:2300 NORTHSIDE XING
Mailing Address - Street 2:STE B
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-2254
Mailing Address - Country:US
Mailing Address - Phone:855-228-4597
Mailing Address - Fax:855-428-4597
Practice Address - Street 1:2300 NORTHSIDE XING
Practice Address - Street 2:STE B
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-2254
Practice Address - Country:US
Practice Address - Phone:855-228-4597
Practice Address - Fax:855-428-4597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-10
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
No293D00000XLaboratoriesPhysiological Laboratory
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies