Healthcare Provider Details

I. General information

NPI: 1851692602
Provider Name (Legal Business Name): CIRCULATORY CENTERS GEORGIA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 BOMBAY LN
ROSWELL GA
30076-5816
US

IV. Provider business mailing address

397 CHURCHILL HUBBARD RD
YOUNGSTOWN OH
44505-1375
US

V. Phone/Fax

Practice location:
  • Phone: 800-526-3082
  • Fax: 330-759-6755
Mailing address:
  • Phone: 330-759-6760
  • Fax: 330-759-6755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number66153
License Number StateGA

VIII. Authorized Official

Name: MR. DAVID A GILPATRICK
Title or Position: PRESIDENT
Credential:
Phone: 412-586-0212