Provider Demographics
NPI:1376527077
Name:SOUTHEASTERN CARDIOLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:SOUTHEASTERN CARDIOLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ABBY
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-243-4506
Mailing Address - Street 1:PO BOX 7067
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-7067
Mailing Address - Country:US
Mailing Address - Phone:706-221-6116
Mailing Address - Fax:706-221-6226
Practice Address - Street 1:2121 WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-7955
Practice Address - Country:US
Practice Address - Phone:706-243-4500
Practice Address - Fax:706-243-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046075207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA06BDHXSMedicare ID - Type Unspecified
GA=========Medicare UPIN