Provider Demographics
NPI:1609016427
Name:VYAS, ASUTOSH (MD)
Entity type:Individual
Prefix:
First Name:ASUTOSH
Middle Name:
Last Name:VYAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3000 CORPORATE CENTER DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-4130
Mailing Address - Country:US
Mailing Address - Phone:770-960-6030
Mailing Address - Fax:770-968-3162
Practice Address - Street 1:3000 CORPORATE CENTER DR
Practice Address - Street 2:SUITE 130
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-4130
Practice Address - Country:US
Practice Address - Phone:770-960-6030
Practice Address - Fax:770-968-3162
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0419932081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA05BDFWJMedicare PIN
GAG57970Medicare UPIN