Basic Information
| Provider Information | |||||||||
| NPI: | 1689845950 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDIOVASCULAR CONSULTANTS OF GEORGIA, P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 FRANCIS WAY | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SHARPSBURG | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702530611 | ||||||||
| FaxNumber: | 7705020521 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 FRANCIS WAY | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | SHARPSBURG | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7702530611 | ||||||||
| FaxNumber: | 7705020521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2008 | ||||||||
| LastUpdateDate: | 03/17/2008 | ||||||||
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| AuthorizedOfficialLastName: | DHRUVA | ||||||||
| AuthorizedOfficialFirstName: | NIMISH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 7702530611 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 045200 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.