Provider Demographics
NPI:1578839296
Name:CARDIOVASCULAR CLINIC OF NORTH GEORGIA PC
Entity Type:Organization
Organization Name:CARDIOVASCULAR CLINIC OF NORTH GEORGIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SALMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHFAQ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-650-0637
Mailing Address - Street 1:1475 JESSE JEWELL PKWY NE STE 300
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3806
Mailing Address - Country:US
Mailing Address - Phone:678-825-3685
Mailing Address - Fax:
Practice Address - Street 1:1475 JESSE JEWELL PKWY NE STE 300
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3806
Practice Address - Country:US
Practice Address - Phone:678-825-3685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-27
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA47878207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI22555Medicare UPIN
GA202G704408Medicare PIN