Healthcare Provider Details

I. General information

NPI: 1699164657
Provider Name (Legal Business Name): GEORGIA PHYSICIANS OF CARDIOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2015
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 PEACH STREET NE, STE 850
ATLANTA GA
30309-3964
US

IV. Provider business mailing address

PO BOX 743266
ATLANTA GA
30374-3266
US

V. Phone/Fax

Practice location:
  • Phone: 404-874-1788
  • Fax: 404-872-4589
Mailing address:
  • Phone: 404-874-1788
  • Fax: 404-872-4589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. WESLEY O. JAMES
Title or Position: REGIONAL CFO, TENET
Credential:
Phone: 404-265-5009