Basic Information
Provider Information
NPI: 1033157011
EntityType: 2
ReplacementNPI:  
OrganizationName: AUGUSTA HEART ASSOCIATES
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: AUGUSTA HEART ASSOCIATES
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 818 ST SEBASTIAN WAY
Address2: STE 308
City: AUGUSTA
State: GA
PostalCode: 309011076
CountryCode: US
TelephoneNumber: 7067244400
FaxNumber: 7067246003
Practice Location
Address1: 818 ST SEBASTIAN WAY
Address2: STE 308
City: AUGUSTA
State: GA
PostalCode: 309011076
CountryCode: US
TelephoneNumber: 7067244400
FaxNumber: 7067246003
Other Information
ProviderEnumerationDate: 06/03/2006
LastUpdateDate: 08/20/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: HOLMAN
AuthorizedOfficialFirstName: MICHAEL
AuthorizedOfficialMiddleName: S
AuthorizedOfficialTitleorPosition: PRESIDENT PHYSICIAN
AuthorizedOfficialTelephone: 7067244400
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000X026558GAY193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

ID Information
IDTypeStateIssuerDescription
00329172E05GA MEDICAID


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