NPIMap

Organization Active NPI

Eastside Vascular Medicine and Surgery, P.C.

  • Specialist
  • Snellville, GA
National Provider Identifier
1861676306
Registry record updated Dec 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
050323 Issued in GA
Legal business name
EASTSIDE VASCULAR MEDICINE AND SURGERY, P.C.
Practice address
1700 Tree Lane Rd
Suite 460
Snellville, GA 30078-6782
Phone
(678) 684-1040
Fax
(678) 684-1045
NPI assigned
Dec 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2007

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

Authorized official

Name
Dr. Junaid Hussain Mudaliar, M.D.NPI 1215904834
Title
President
Phone
(678) 684-1040

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 050323 GA Primary

Addresses

Primary practice location

1700 Tree Lane Rd
Suite 460
Snellville, GA 30078-6782

Mailing address

1700 Tree Lane Rd
Suite 460
Snellville, GA 30078-6782
Phone (678) 684-1040

National Provider Directory

National Provider Directory

Locations

1700 Tree Ln
Ste 460
Snellville, GA 30078
Phone (678) 681-1040

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1198022400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198022400000",
    "number": "1861676306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1700 TREE LANE RD",
            "address_2": "SUITE 460",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300786782",
            "telephone_number": "678-684-1040",
            "fax_number": "678-684-1045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1700 TREE LANE RD",
            "address_2": "SUITE 460",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300786782",
            "telephone_number": "678-684-1040",
            "fax_number": "678-684-1045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTSIDE VASCULAR MEDICINE AND SURGERY, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-19",
        "last_updated": "2007-12-19",
        "status": "A",
        "authorized_official_last_name": "MUDALIAR",
        "authorized_official_first_name": "JUNAID",
        "authorized_official_middle_name": "HUSSAIN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-684-1040",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": "050323",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Snellville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2007; 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.