Provider Demographics
NPI:1124194055
Name:CARDIOLOGY CONSULTANTS OF SOUTH GEORGIA, PC
Entity Type:Organization
Organization Name:CARDIOLOGY CONSULTANTS OF SOUTH GEORGIA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:P
Authorized Official - Last Name:SLAUGHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-551-0083
Mailing Address - Street 1:100 MIMOSA DR
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-6676
Mailing Address - Country:US
Mailing Address - Phone:229-551-0083
Mailing Address - Fax:229-227-9642
Practice Address - Street 1:100 MIMOSA DR FL 2
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-6676
Practice Address - Country:US
Practice Address - Phone:229-551-0083
Practice Address - Fax:229-227-9642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4911Medicare ID - Type UnspecifiedGROUP PROVIDER NUMBER