MEDICARE: CARDIAC DISEASE SPECIALISTS, 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	207RI0011X	Interventional Cardiology Physician
2	207RC0000X	Cardiovascular Disease Physician

General Provider Information

NPI Number	:	1811082605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARDIAC DISEASE SPECIALISTS, PC

Provider Business Mailing Address
First Line	:	275 COLLIER RD NW
Second Line	:	STE 300
City	:	ATLANTA
State	:	GA
Zip	:	30309-1704
Country	:	US
Telephone Number	:	404-355-9815
Fax Number	:	404-350-0529

Provider Business Practice Location Address
First Line	:	296 MERCHANTS SQ
Second Line	:
City	:	DALLAS
State	:	GA
Zip	:	30132-5029
Country	:	US
Telephone Number	:	678-363-3200
Fax Number	:	678-363-9644

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HARVEY N SACKS
Credential	:	MD
Telephone Number	:	404-355-9815

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	11/08/2007

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