Healthcare Provider Details

I. General information

NPI: 1891918264
Provider Name (Legal Business Name): DUBLIN-MACON CARDIOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206A HOSPITAL DR
DUBLIN GA
31021-2989
US

IV. Provider business mailing address

PO BOX 16700
DUBLIN GA
31040-6700
US

V. Phone/Fax

Practice location:
  • Phone: 478-272-3525
  • Fax: 478-272-3589
Mailing address:
  • Phone: 478-272-3525
  • Fax: 478-272-3504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MANUEL A VEGA
Title or Position: PHYSICIAN/ OWNER
Credential: MD, FACC,FSCAI
Phone: 478-272-3525