Provider Demographics
NPI:1528596863
Name:CHILDREN'S HEART SPECIALISTS OF GEORGIA, P.C.
Entity Type:Organization
Organization Name:CHILDREN'S HEART SPECIALISTS OF GEORGIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGE
Authorized Official - Middle Name:
Authorized Official - Last Name:GEFFRARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-840-2288
Mailing Address - Street 1:4904 TIMBER RIDGE DR STE 202A
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-1831
Mailing Address - Country:US
Mailing Address - Phone:678-840-2288
Mailing Address - Fax:678-840-3982
Practice Address - Street 1:4904 TIMBER RIDGE DR STE 202A
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1831
Practice Address - Country:US
Practice Address - Phone:678-840-2288
Practice Address - Fax:678-840-3982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057076174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty