Healthcare Provider Details

I. General information

NPI: 1740458892
Provider Name (Legal Business Name): ATLANTA CARDIOLOGY AND PRIMARY CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2008
Last Update Date: 02/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3562 HABERSHAM AT NORTHLAKE BLDG J
TUCKER GA
30084-4009
US

IV. Provider business mailing address

3562 HABERSHAM AT NORTHLAKE BLDG J
TUCKER GA
30084-4009
US

V. Phone/Fax

Practice location:
  • Phone: 404-296-1130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number47506
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number037251
License Number StateGA

VIII. Authorized Official

Name: DR. SYED T RAHMAN
Title or Position: COO
Credential: MD
Phone: 404-296-1130