Provider Demographics
NPI:1477861557
Name:GAINESVILLE HEART AND VASCULAR GROUP PC
Entity Type:Organization
Organization Name:GAINESVILLE HEART AND VASCULAR GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-534-9014
Mailing Address - Street 1:705 JESSE JEWELL PKWY SE STE 200
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3868
Mailing Address - Country:US
Mailing Address - Phone:770-534-9014
Mailing Address - Fax:770-534-9012
Practice Address - Street 1:705 JESSE JEWELL PKWY SE STE 200
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3868
Practice Address - Country:US
Practice Address - Phone:770-534-9014
Practice Address - Fax:770-534-9012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2011-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty