MEDICARE: PIEDMONT CARDIOLOGY OF ATLANTA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	08062020	GA
2	207RC0001X	Clinical Cardiac Electrophysiology Physician
3	207RI0011X	Interventional Cardiology Physician
4	207RC0000X	Cardiovascular Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275729691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIEDMONT CARDIOLOGY OF ATLANTA, LLC

Provider Business Mailing Address
First Line	:	PO BOX 116116
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30368-1711
Country	:	US
Telephone Number	:	770-801-2500
Fax Number	:	770-803-2121

Provider Business Practice Location Address
First Line	:	275 COLLIER ROAD
Second Line	:	SUITE 300
City	:	ATLANTA
State	:	GA
Zip	:	30309-1711
Country	:	US
Telephone Number	:	404-605-2800
Fax Number	:	404-351-5983

Authorized Official
Title or Position	:	DIRECTOR OF PROVIDER ENROLLMENT
Name	:	MRS. CHRISTY AQUINO
Credential	:
Telephone Number	:	470-271-3427

Provider Enumeration Date	:	09/19/2007
Last Update Date	:	09/16/2022

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