Healthcare Provider Details

I. General information

NPI: 1023183399
Provider Name (Legal Business Name): CARDIOPULMONARY ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 09/08/2022
Certification Date: 09/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 PINE ST SUITE 310
MACON GA
31201-2173
US

IV. Provider business mailing address

770 PINE ST SUITE 310
MACON GA
31201-2173
US

V. Phone/Fax

Practice location:
  • Phone: 478-741-1118
  • Fax: 478-750-9301
Mailing address:
  • Phone: 478-741-1118
  • Fax: 478-750-9301

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 Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RAMANA V KALLI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 478-741-1118