AVVSC LAWRENCEVILLE LLC NPI 1427435007

NPI Information

NPI: 1427435007
Provider Name: AVVSC LAWRENCEVILLE, LLC
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 11D2108805

Address:
600 PROFESSIONAL DR
SUITE 160B
LAWRENCEVILLE, GA
ZIP 30046
Phone: (678) 878-4555
Get Directions

AVVSC LAWRENCEVILLE, LLC is an ambulatory surgical clinic center in Lawrenceville, GA. AVVSC LAWRENCEVILLE, LLC NPI is 1427435007. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

600 PROFESSIONAL DR
SUITE 160B
LAWRENCEVILLE, GA
ZIP 30046-651
Phone: (678) 878-4555
Fax: (678) 878-4556

The provider's authorized official is Amish Tilara .
The authorized official title is President and has the following contact phone number (678) 878-4555.

The CLIA number assigned to this NPI record is 11D2108805 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/2/2015 and was last updated on 6/30/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	2085R0204X	Radiology	Vascular & Interventional Radiology	No
2	261QM2500X	Clinic/Center	Medical Specialty	No
3	261QR0200X	Clinic/Center	Radiology	No
4	261QA1903X	Clinic/Center	Ambulatory Surgical	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	11C0001456	MEDICAID	GEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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