Healthcare Provider Details

I. General information

NPI: 1205651510
Provider Name (Legal Business Name): HEART AND VASCULAR CARE EAST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2024
Last Update Date: 12/31/2024
Certification Date: 12/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3970 DEPUTY BILL CANTRELL MEM STE 100
CUMMING GA
30040-3069
US

IV. Provider business mailing address

1720 WINDWARD CONCOURSE STE 390
ALPHARETTA GA
30005-2293
US

V. Phone/Fax

Practice location:
  • Phone: 678-513-2273
  • Fax: 678-513-8869
Mailing address:
  • Phone: 678-513-2273
  • Fax: 678-513-8869

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: LARAMI OLIVER
Title or Position: RCM DIRECTOR
Credential:
Phone: 678-513-2273