Healthcare Provider Details

I. General information

NPI: 1780779363
Provider Name (Legal Business Name): CENTRAL GEORGIA HEART CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1062 FORSYTH ST., SUITE 1B
MACON GA
31201
US

IV. Provider business mailing address

1062 FORSYTH ST., SUITE 1B
MACON GA
31201
US

V. Phone/Fax

Practice location:
  • Phone: 478-741-1208
  • Fax: 478-741-1557
Mailing address:
  • Phone: 478-741-1208
  • Fax: 478-741-1557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateGA

VIII. Authorized Official

Name: MR. MARK EDWARD DOROGY
Title or Position: PRESIDENT
Credential: MD
Phone: 478-955-5126