Provider Demographics
NPI:1407802978
Name:CARDIOVASCULAR IMAGING OF NORTH GEORGIA LLC
Entity Type:Organization
Organization Name:CARDIOVASCULAR IMAGING OF NORTH GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COORDINATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:KNAPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-636-6500
Mailing Address - Street 1:1100 JOHNSON FERRY RD NE
Mailing Address - Street 2:SUITE 1065
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1709
Mailing Address - Country:US
Mailing Address - Phone:404-851-5415
Mailing Address - Fax:404-303-2393
Practice Address - Street 1:97 HEFNER ST
Practice Address - Street 2:SUITE 102
Practice Address - City:EAST ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-8260
Practice Address - Country:US
Practice Address - Phone:706-636-6500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017225207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty