=====================================================
General NPI Number Information
=====================================================
NPI Number | 1275978439
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ATLANTA CARDIOLOGY ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2013
-----------------------------------------------------
Last Update Date | 01/14/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11680 GREAT OAKS WAY STE 100
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30022-2458
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-272-4888
-----------------------------------------------------
Fax | 404-796-7099
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 385 LUM CROWE RD
-----------------------------------------------------
City | ROSWELL
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30075-6879
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-272-4888
-----------------------------------------------------
Fax | 404-796-7099
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. WINSTON HAROLD GANDY JR.
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 404-272-4888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | 30065
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------