Healthcare Provider Details

I. General information

NPI: 1275978439
Provider Name (Legal Business Name): ATLANTA CARDIOLOGY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 01/14/2024
Certification Date: 01/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11680 GREAT OAKS WAY STE 100
ALPHARETTA GA
30022-2458
US

IV. Provider business mailing address

385 LUM CROWE RD
ROSWELL GA
30075-6879
US

V. Phone/Fax

Practice location:
  • Phone: 404-272-4888
  • Fax: 404-796-7099
Mailing address:
  • Phone: 404-272-4888
  • Fax: 404-796-7099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number30065
License Number StateGA

VIII. Authorized Official

Name: DR. WINSTON HAROLD GANDY JR.
Title or Position: CEO
Credential: M.D.
Phone: 404-272-4888