Provider Demographics
NPI:1003934480
Name:CHILDREN'S CARRDIOVASCULAR MEDICINE P.C
Entity Type:Organization
Organization Name:CHILDREN'S CARRDIOVASCULAR MEDICINE P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTANA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:404-943-0289
Mailing Address - Street 1:61 WHITCHER ST NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1176
Mailing Address - Country:US
Mailing Address - Phone:404-943-0289
Mailing Address - Fax:404-943-9787
Practice Address - Street 1:61 WHITCHER ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1176
Practice Address - Country:US
Practice Address - Phone:404-943-0289
Practice Address - Fax:404-943-9787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty