Healthcare Provider Details

I. General information

NPI: 1861566838
Provider Name (Legal Business Name): AUGUSTA CARDIOLOGY CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 SAINT SEBASTIAN WAY STE 311
AUGUSTA GA
30901-2653
US

IV. Provider business mailing address

818 SAINT SEBASTIAN WAY STE 311
AUGUSTA GA
30901-2653
US

V. Phone/Fax

Practice location:
  • Phone: 706-724-3473
  • Fax: 706-724-3493
Mailing address:
  • Phone: 706-724-3473
  • Fax: 706-724-3493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID M CLARK II
Title or Position: OFFICER
Credential: MD
Phone: 706-724-3473