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General NPI Number Information
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NPI Number | 1518902147
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Entity Type | Organization
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Legal Business Name | CARDIOVASCULAR ASSOCIATES OF EASTERN GEORGIA
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Dates
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Enumeration Date | 06/18/2006
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Last Update Date | 02/13/2018
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Provider Practice Location Address
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Address Line | 1497 FAIR RD SUITE 305
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City | STATESBORO
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State | GA
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Zip | 30458-0822
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Country | US
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Telephone | 912-681-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 1497 FAIR RD SUITE 305
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City | STATESBORO
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State | GA
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Zip | 30458-0822
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | AJAY JAIN
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Credential |
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Telephone | 912-681-2273
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 58253
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License Number State | GA
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