Provider Demographics
NPI:1376843003
Name:NORTHSIDE CARDIOLOGY-ELECTROPHYSIOLOGY, LLC
Entity Type:Organization
Organization Name:NORTHSIDE CARDIOLOGY-ELECTROPHYSIOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BEENA
Authorized Official - Middle Name:B
Authorized Official - Last Name:ALEX
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, MHA
Authorized Official - Phone:404-845-4728
Mailing Address - Street 1:5670 PEACHTREE DUNWOODY RD NE
Mailing Address - Street 2:SUITE 880
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1699
Mailing Address - Country:US
Mailing Address - Phone:404-256-2525
Mailing Address - Fax:404-845-4732
Practice Address - Street 1:5670 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:SUITE 880
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1699
Practice Address - Country:US
Practice Address - Phone:404-256-2525
Practice Address - Fax:404-845-4732
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHSIDE CARDIOLOGY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-28
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty