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General NPI Number Information
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NPI Number | 1902452774
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Entity Type | Organization
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Legal Business Name | CARDIOLOGY CARE CLINIC, LLC
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Dates
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Enumeration Date | 08/16/2019
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Last Update Date | 07/27/2020
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Provider Practice Location Address
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Address Line | 119 HARMONY XING STE 3
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City | EATONTON
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State | GA
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Zip | 31024-9571
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Country | US
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Telephone | 706-485-4004
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Fax | 706-262-2986
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Provider Business Mailing Address
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Address Line | 119 HARMONY XING STE 3
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City | EATONTON
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State | GA
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Zip | 31024-9571
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Country | US
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Telephone | 706-485-4004
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Fax | 706-484-2453
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Authorized Official
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Title or Position | OWNER
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Name | NICOLAS A.F. CHRONOS
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Credential | MD
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Telephone | 706-485-4004
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0404X
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Taxonomy Name | Cardiac Rehabilitation Clinic/Center
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License Number |
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License Number State |
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