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General NPI Number Information
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NPI Number | 1568639888
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Entity Type | Organization
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Legal Business Name | CARDIAC DISEASE SPECIALISTS, P.C.
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 1720 PHOENIX BLVD SUITE 200
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City | COLLEGE PARK
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State | GA
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Zip | 30349-5594
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Country | US
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Telephone | 770-997-9928
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Fax |
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Provider Business Mailing Address
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Address Line | 275 COLLIER RD NW SUITE 300
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City | ATLANTA
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State | GA
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Zip | 30309-1709
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Country | US
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Telephone | 404-355-9815
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Fax | 494-350-0529
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Authorized Official
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Title or Position | PHYSICIAN
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Name | HAROLD D CARLSON
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Credential | MD
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Telephone | 404-355-9815
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 027508
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License Number State | GA
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