NPIMap

Organization Active NPI

Avvc Medical, LLC

  • Radiology Clinic/Center
  • Lawrenceville, GA
National Provider Identifier
1720512635
Registry record updated Apr 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
AVVC MEDICAL, LLC
Practice address
600 Professional Dr
Lawrenceville, GA 30046-7651
Phone
(678) 878-4555
NPI assigned
Apr 18, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2017

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

Authorized official

Name
Dr. Amish Tilara, MDNPI 1912221359
Title
President
Phone
(678) 878-4555

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X Primary

Addresses

Primary practice location

600 Professional Dr
Lawrenceville, GA 30046-7651

Mailing address

600 Professional Dr
Lawrenceville, GA 30046-7651

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1492473600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492473600000",
    "number": "1720512635",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 PROFESSIONAL DR",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300467651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 PROFESSIONAL DR",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300467651",
            "telephone_number": "678-878-4555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVVC MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-18",
        "last_updated": "2017-04-18",
        "status": "A",
        "authorized_official_last_name": "TILARA",
        "authorized_official_first_name": "AMISH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-878-4555",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2017; 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.