Basic Information
| Provider Information | |||||||||
| NPI: | 1891918264 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DUBLIN-MACON CARDIOLOGY, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 16700 | ||||||||
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| City: | DUBLIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310406700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4782723525 | ||||||||
| FaxNumber: | 4782723504 | ||||||||
| Practice Location | |||||||||
| Address1: | 206A HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | GA | ||||||||
| PostalCode: | 310212989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4782723525 | ||||||||
| FaxNumber: | 4782723589 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2007 | ||||||||
| LastUpdateDate: | 07/17/2012 | ||||||||
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| AuthorizedOfficialLastName: | VEGA | ||||||||
| AuthorizedOfficialFirstName: | MANUEL | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN/ OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4782723525 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD, FACC,FSCAI | ||||||||
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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 | 207UN0901X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Nuclear Medicine | Nuclear Cardiology | 207RC0000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.