Healthcare Provider Details

I. General information

NPI: 1033157011
Provider Name (Legal Business Name): AUGUSTA HEART ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 ST SEBASTIAN WAY STE 308
AUGUSTA GA
30901-1076
US

IV. Provider business mailing address

818 ST SEBASTIAN WAY STE 308
AUGUSTA GA
30901-1076
US

V. Phone/Fax

Practice location:
  • Phone: 706-724-4400
  • Fax: 706-724-6003
Mailing address:
  • Phone: 706-724-4400
  • Fax: 706-724-6003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number026558
License Number StateGA

VIII. Authorized Official

Name: MICHAEL S HOLMAN
Title or Position: PRESIDENT PHYSICIAN
Credential: MD
Phone: 706-724-4400