MEDICARE: ATLANTA CARDIAC & THORACIC SURGERY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376753970
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATLANTA CARDIAC & THORACIC SURGERY

Provider Business Mailing Address
First Line	:	960 JOHNSON FERRY RD NE STE 100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1601
Country	:	US
Telephone Number	:	404-252-9063
Fax Number	:	404-252-0873

Provider Business Practice Location Address
First Line	:	960 JOHNSON FERRY RD NE STE 100
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1601
Country	:	US
Telephone Number	:	404-252-9063
Fax Number	:	404-252-0873

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	STEVE COOK
Credential	:
Telephone Number	:	404-252-9063

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	01/13/2010

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