Provider Demographics
NPI:1003247842
Name:SOUTHERN CARDIOVASCULAR CARE, PC
Entity Type:Organization
Organization Name:SOUTHERN CARDIOVASCULAR CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SRINIVASA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHENNAREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:334-699-8900
Mailing Address - Street 1:1800 FAIRVIEW AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-3059
Mailing Address - Country:US
Mailing Address - Phone:334-699-8900
Mailing Address - Fax:334-699-7498
Practice Address - Street 1:1800 FAIRVIEW AVE STE 1
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-3059
Practice Address - Country:US
Practice Address - Phone:334-699-8900
Practice Address - Fax:334-699-7498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-04
Last Update Date:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29602174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty