Healthcare Provider Details
I. General information
NPI: 1508143835
Provider Name (Legal Business Name): COMPREHENSIVE CARDIAC CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/15/2011
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1654 WATSON BLVD
WARNER ROBINS GA
31093-3439
US
IV. Provider business mailing address
PO BOX 14485
MACON GA
31203-4485
US
V. Phone/Fax
- Phone: 478-737-9555
- Fax:
- Phone: 478-737-9555
- Fax: 478-742-5048
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207RC0000X |
| Taxonomy | Cardiovascular Disease Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207RI0011X |
| Taxonomy | Interventional Cardiology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
GOHAR
SAEED
Title or Position: PARTNER
Credential: M.D
Phone: 478-737-9555