Atlanta Minimally Invasive Surgical Assoc LLC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

043259 Issued in GA

Legal business name

ATLANTA MINIMALLY INVASIVE SURGICAL ASSOC LLC

Practice address

1136 Cleveland Ave
Suite 611
East Point, GA 30344-3618

Phone

(770) 378-2449

Fax

(770) 252-8425

NPI assigned

Dec 16, 2013

Last updated

Dec 16, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Vijaykumar G Patel, MD

Title

Owner/President

Phone

(770) 378-2449

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1387152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387152000000",
    "number": "1144641291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3335",
            "city": "PEACHTREE CITY",
            "state": "GA",
            "postal_code": "302697335",
            "telephone_number": "770-378-2449",
            "fax_number": "770-252-8425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1136 CLEVELAND AVE",
            "address_2": "SUITE 611",
            "city": "EAST POINT",
            "state": "GA",
            "postal_code": "303443618",
            "telephone_number": "770-378-2449",
            "fax_number": "770-252-8425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTA MINIMALLY INVASIVE SURGICAL ASSOC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-16",
        "last_updated": "2013-12-16",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "VIJAYKUMAR",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "770-378-2449",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "GA",
            "license": "043259",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000748294",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.