Healthcare Provider Details

I. General information

NPI: 1205901022
Provider Name (Legal Business Name): ATLANTA HEART CENTER LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 OAKSIDE LN SUITE C
CANTON GA
30114-6417
US

IV. Provider business mailing address

210 OAKSIDE LN SUITE C
CANTON GA
30114-6417
US

V. Phone/Fax

Practice location:
  • Phone: 770-704-1955
  • Fax: 770-720-2388
Mailing address:
  • Phone: 770-704-1955
  • Fax: 770-720-2388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number050581
License Number StateGA

VIII. Authorized Official

Name: DR. ERNESTO E HERNANDEZ
Title or Position: CARDIOLOGIST
Credential: MD
Phone: 770-704-1955