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General NPI Number Information
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NPI Number | 1962671347
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Entity Type | Organization
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Legal Business Name | EAST COBB CARDIOLOGY LLC
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Dates
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Enumeration Date | 02/29/2008
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Last Update Date | 02/29/2008
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Provider Practice Location Address
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Address Line | 100 MARKET PLACE BLVD SUITE 300
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City | CARTERSVILLE
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State | GA
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Zip | 30121-8717
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Country | US
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Telephone | 770-427-0035
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Fax | 678-819-3549
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Provider Business Mailing Address
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Address Line | 100 MARKET PLACE BLVD SUITE 300
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City | CARTERSVILLE
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State | GA
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Zip | 30121-8718
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Country | US
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Telephone | 678-605-9095
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Fax | 678-605-9096
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Authorized Official
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Title or Position | OWNER
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Name | MRS. NYDIA MARIE BLADUELL
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Credential | MD
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Telephone | 770-427-0035
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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 |
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License Number State | GA
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