Atlanta Vein Clinic, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

059827 Issued in GA

Legal business name

ATLANTA VEIN CLINIC, LLC

Practice address

4060 Johns Creek Pkwy
Building E
Suwanee, GA 30024-1230

Phone

(404) 805-6167

NPI assigned

Sep 26, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Chalam Mahadevan, MDNPI 1447463609

Title

Owner

Phone

(404) 805-6167

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Atlanta Vein Specialists Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Chalam Mahadevan, M.D.

  • Surgery Physician
  • Suwanee, GA
  • NPI 1447463609

  GA

  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222387200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1668729600000",
    "number": "1104076009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4060 JOHNS CREEK PKWY",
            "address_2": "BUILDING E",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300241230",
            "telephone_number": "678-615-3511",
            "fax_number": "678-395-4642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4060 JOHNS CREEK PKWY",
            "address_2": "BUILDING E",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300241230",
            "telephone_number": "404-805-6167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTA VEIN CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-26",
        "last_updated": "2022-11-18",
        "certification_date": "2022-11-18",
        "status": "A",
        "authorized_official_last_name": "MAHADEVAN",
        "authorized_official_first_name": "CHALAM",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "404-805-6167",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "059827",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1447463609",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Atlanta Vein Specialists",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Suwanee, GA
• Ambulatory Surgical Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.