Provider Demographics
NPI:1043425705
Name:CARDIOLOGY GROUP, PC
Entity Type:Organization
Organization Name:CARDIOLOGY GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILBURN
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:931-393-7831
Mailing Address - Street 1:PO BOX 938
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-0938
Mailing Address - Country:US
Mailing Address - Phone:931-393-4764
Mailing Address - Fax:931-393-4766
Practice Address - Street 1:1801 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-2201
Practice Address - Country:US
Practice Address - Phone:931-393-7831
Practice Address - Fax:931-393-7833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1205921152OtherNPI CONNIE LEANZA
TN3085951Medicaid
TN3883725Medicaid
TN3906568Medicaid
TN1831182443OtherNPI DINESH GUPTA
TN1902862519OtherNPI WILBURN GEORGE
TN3014316Medicaid
TN3883725Medicare ID - Type Unspecified
TN3014373Medicare ID - Type Unspecified
TN3883725Medicaid
TN3906568Medicaid
TN1831182443OtherNPI DINESH GUPTA
TN3085951Medicare ID - Type Unspecified
TNB42092Medicare UPIN
TN3085951Medicaid