Provider Demographics
NPI:1407994437
Name:GEORGIA HEART PHYSICIANS LLC
Entity Type:Organization
Organization Name:GEORGIA HEART PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:OBINNAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:EMEROLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-738-9443
Mailing Address - Street 1:PO BOX 6135
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208
Mailing Address - Country:US
Mailing Address - Phone:478-738-9443
Mailing Address - Fax:478-738-9750
Practice Address - Street 1:654 FIRST ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201
Practice Address - Country:US
Practice Address - Phone:478-738-9443
Practice Address - Fax:478-738-9750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G01031Medicare UPIN
F66821Medicare UPIN
GAGRP3732Medicare ID - Type Unspecified