Healthcare Provider Details

I. General information

NPI: 1679945596
Provider Name (Legal Business Name): ATHENS CARDIAC CLINIC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 10/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 CADUCEUS WAY BUILDING 600 SUITE 105
WATKINSVILLE GA
30677-7300
US

IV. Provider business mailing address

1720 EPPS BRIDGE PKWY SUITE 108 #136
ATHENS GA
30606-6132
US

V. Phone/Fax

Practice location:
  • Phone: 470-240-2224
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number056494
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number056494
License Number StateGA

VIII. Authorized Official

Name: ROHIT TONGIA
Title or Position: MD
Credential:
Phone: 770-868-6254