Provider Demographics
NPI:1386455582
Name:ADVANCED UROLOGY INSTITUTE OF GEORGIA, PC
Entity type:Organization
Organization Name:ADVANCED UROLOGY INSTITUTE OF GEORGIA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BEEMAL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-951-8657
Mailing Address - Street 1:1551 JANMAR RD
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5606
Mailing Address - Country:US
Mailing Address - Phone:470-579-5600
Mailing Address - Fax:
Practice Address - Street 1:49 GORDON RD
Practice Address - Street 2:SUITE 103
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-1017
Practice Address - Country:US
Practice Address - Phone:678-344-8900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty