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General NPI Number Information
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NPI Number | 1851611651
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Entity Type | Organization
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Legal Business Name | EAST ATLANTA CARDIOLOGY LLC
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Dates
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Enumeration Date | 06/03/2010
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 1372 WELLBROOK CIR NE
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City | CONYERS
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State | GA
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Zip | 30012-3872
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Country | US
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Telephone | 770-322-8881
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Fax | 770-322-8886
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Provider Business Mailing Address
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Address Line | 5255 SNAPFINGER PARK DR SUITE 130
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City | DECATUR
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State | GA
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Zip | 30035-4084
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Country | US
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Telephone | 770-322-8881
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Fax | 770-322-8886
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Authorized Official
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Title or Position | MD, CEO
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Name | DR. MUTHAYYAH SRINIVASAN
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Credential | MD
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Telephone | 770-322-8881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 52836
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License Number State | GA
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