Healthcare Provider Details

I. General information

NPI: 1487656930
Provider Name (Legal Business Name): STUART A CAVALIERI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 FREEDOM WAY CARDIOLOGY SECTION (251)
AUGUSTA GA
30904-6258
US

IV. Provider business mailing address

1 FREEDOM WAY CARDIOLOGY SECTION (251)
AUGUSTA GA
30904-6258
US

V. Phone/Fax

Practice location:
  • Phone: 706-733-0188
  • Fax: 706-823-3911
Mailing address:
  • Phone: 706-733-0188
  • Fax: 706-823-3911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD00037637
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD00037637
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: