MEDICARE: TOTAL CARDIOLOGY OF ATLANTA

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	207RC0001X	Clinical Cardiac Electrophysiology Physician	059778	GA

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	:	1770962508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL CARDIOLOGY OF ATLANTA

Provider Business Mailing Address
First Line	:	285 BOULEVARD NE STE 115
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-4207
Country	:	US
Telephone Number	:	678-995-5068
Fax Number	:	470-575-5849

Provider Business Practice Location Address
First Line	:	285 BOULEVARD NE STE 115
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-4207
Country	:	US
Telephone Number	:	678-995-5068
Fax Number	:	470-575-5849

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MRS. SHAREE DEARHOLT
Credential	:
Telephone Number	:	678-995-5068

Provider Enumeration Date	:	05/26/2015
Last Update Date	:	11/07/2024

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