Basic Information
| Provider Information | |||||||||
| NPI: | 1053344341 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDIOVASCULAR ASSOCIATES OF AUGUSTA, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1348 WALTON WAY | ||||||||
| Address2: | SUITE 5100 | ||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067248611 | ||||||||
| FaxNumber: | 7068218110 | ||||||||
| Practice Location | |||||||||
| Address1: | 1348 WALTON WAY | ||||||||
| Address2: | SUITE 5100 | ||||||||
| City: | AUGUSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067248611 | ||||||||
| FaxNumber: | 7068218110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/09/2006 | ||||||||
| LastUpdateDate: | 05/10/2010 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | RAY | ||||||||
| AuthorizedOfficialMiddleName: | EDWARD | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7067248611 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 017835 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.