MEDICARE: THE ATLANTA CARDIOLOGY GROUP, PC

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

General Provider Information

NPI Number	:	1407904980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ATLANTA CARDIOLOGY GROUP, PC

Provider Business Mailing Address
First Line	:	134 ANSLEY DR
Second Line	:	SUITE 400
City	:	DAHLONEGA
State	:	GA
Zip	:	30533-1614
Country	:	US
Telephone Number	:	706-864-6136
Fax Number	:	706-864-4912

Provider Business Practice Location Address
First Line	:	134 ANSLEY DR
Second Line	:	SUITE 400
City	:	DAHLONEGA
State	:	GA
Zip	:	30533-1614
Country	:	US
Telephone Number	:	706-864-6136
Fax Number	:	706-864-4912

Authorized Official
Title or Position	:	CFO
Name	:	JOHN BOWEN
Credential	:
Telephone Number	:	678-242-1999

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	11/16/2007

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