Basic Information
| Provider Information | |||||||||
| NPI: | 1568639888 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDIAC DISEASE SPECIALISTS, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 275 COLLIER RD NW | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303091709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043559815 | ||||||||
| FaxNumber: | 4943500529 | ||||||||
| Practice Location | |||||||||
| Address1: | 1720 PHOENIX BLVD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | COLLEGE PARK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303495594 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709979928 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/15/2008 | ||||||||
| LastUpdateDate: | 05/15/2008 | ||||||||
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| AuthorizedOfficialLastName: | CARLSON | ||||||||
| AuthorizedOfficialFirstName: | HAROLD | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 4043559815 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 027508 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.