Basic Information
| Provider Information | |||||||||
| NPI: | 1689769507 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CARDIAC DISEASE SPECIALISTS, PC | ||||||||
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| OtherOrganizationName: | CARDIAC DISEASE SPECIALISTS, PC-FAYETTEVILLE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 275 COLLIER RD NW | ||||||||
| Address2: | STE 300 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303091704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043559815 | ||||||||
| FaxNumber: | 4043500529 | ||||||||
| Practice Location | |||||||||
| Address1: | 1267 HIGHWAY 54 W | ||||||||
| Address2: | STE 2200 | ||||||||
| City: | FAYETTEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 302144548 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707160051 | ||||||||
| FaxNumber: | 7707160087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 11/08/2007 | ||||||||
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| AuthorizedOfficialLastName: | SACKS | ||||||||
| AuthorizedOfficialFirstName: | HARVEY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| 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 | 207RI0011X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 207RC0000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.