Healthcare Provider Details

I. General information

NPI: 1669655874
Provider Name (Legal Business Name): GEORGIA THORACIC & CARDIOVASCULAR SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 JOHNSON FERRY RD SUITE 518
ATLANTA GA
30342
US

IV. Provider business mailing address

960 JOHNSON FERRY RD SUITE 518
ATLANTA GA
30342
US

V. Phone/Fax

Practice location:
  • Phone: 678-904-5182
  • Fax: 678-904-5186
Mailing address:
  • Phone: 678-904-5182
  • Fax: 678-904-5186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number037035
License Number StateGA

VIII. Authorized Official

Name: ANIKA MORMAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 678-904-5182