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NPI Code Detail

MEDICARE: CARDIOLOGY ASSOCIATES OF VIDALIA, P.C.

MEDICARE: CARDIOLOGY ASSOCIATES OF VIDALIA, P.C.
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
1207RI0011XInterventional Cardiology Physician025159GA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3060062628OTHERGARAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2252783403OTHERGATRICARE
41104827369OTHERGANPI - INDIVIDUAL

General Provider Information

NPI Number : 1356530901
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARDIOLOGY ASSOCIATES OF VIDALIA, P.C.
Provider Business Mailing Address
First Line : 1006 MOUNT VERNON RD
Second Line :
City : VIDALIA
State : GA
Zip : 30474-3029
Country : US
Telephone Number : 912-537-1221
Fax Number : 912-537-1012
Provider Business Practice Location Address
First Line : 1006 MOUNT VERNON RD
Second Line :
City : VIDALIA
State : GA
Zip : 30474-3029
Country : US
Telephone Number : 912-537-1221
Fax Number : 912-537-1012
Authorized Official
Title or Position : OFFICE MANAGER
Name : MS. ELAINE GILES
Credential :
Telephone Number : 912-537-1221
Provider Enumeration Date : 10/19/2007
Last Update Date : 04/20/2015

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1114359916 — PAUL JOSEPH GILES, M.D., LLC
Practice Location Address:
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Practice Phone: 912-537-1221
Practice Fax: 912-537-1012

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