Basic Information
| Provider Information | |||||||||
| NPI: | 1790881456 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDIOVASCULAR PHYSICIANS OF NORTH ATLANTA, P.C. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CPNA | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1285 UPPER HEMBREE RD | ||||||||
| Address2: | |||||||||
| City: | ROSWELL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300761143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703438565 | ||||||||
| FaxNumber: | 7703438651 | ||||||||
| Practice Location | |||||||||
| Address1: | 1285 UPPER HEMBREE RD | ||||||||
| Address2: | |||||||||
| City: | ROSWELL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300761143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7703438565 | ||||||||
| FaxNumber: | 7703438651 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2006 | ||||||||
| LastUpdateDate: | 09/03/2008 | ||||||||
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| AuthorizedOfficialLastName: | BALBOA | ||||||||
| AuthorizedOfficialFirstName: | SUZANNE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6782422020 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.