Healthcare Provider Details

I. General information

NPI: 1760576656
Provider Name (Legal Business Name): ATLANTA HEART GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2665 N DECATUR ROAD SUITE 260
DECATUR GA
30033-6145
US

IV. Provider business mailing address

2665 N DECATUR ROAD SUITE 260
DECATUR GA
30033-6145
US

V. Phone/Fax

Practice location:
  • Phone: 404-297-9077
  • Fax: 404-296-1220
Mailing address:
  • Phone: 404-297-9077
  • Fax: 404-296-1220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number021728
License Number StateGA

VIII. Authorized Official

Name: DR. PAUL A KIRSCHBAUM
Title or Position: PRESIDENT
Credential: MD
Phone: 404-297-9077