Healthcare Provider Details

I. General information

NPI: 1619703667
Provider Name (Legal Business Name): CARDIAC CARE SPECIALISTS OF DUBLIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 FAIRVIEW PARK DR STE 200
DUBLIN GA
31021-2547
US

IV. Provider business mailing address

202 FAIRVIEW PARK DR STE 200
DUBLIN GA
31021-2547
US

V. Phone/Fax

Practice location:
  • Phone: 478-246-2264
  • Fax:
Mailing address:
  • Phone: 478-246-2264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SURENDER MALHOTRA
Title or Position: MD
Credential:
Phone: 478-246-2264