Provider Demographics
NPI:1306185491
Name:GWINNETT CARDIOLOGY SERVICES LLC
Entity Type:Organization
Organization Name:GWINNETT CARDIOLOGY SERVICES LLC
Other - Org Name:CARDIOVASCULAR GROUP PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VP ADMIN; CCO
Authorized Official - Prefix:MR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-851-6378
Mailing Address - Street 1:1000 JOHNSON FERRY ROAD
Mailing Address - Street 2:ATTN: JORGE HERNANDEZ
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1170
Mailing Address - Country:US
Mailing Address - Phone:404-851-6378
Mailing Address - Fax:
Practice Address - Street 1:755 WALTHER RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8725
Practice Address - Country:US
Practice Address - Phone:855-709-4535
Practice Address - Fax:770-339-3459
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHSIDE HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-08
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty