Provider Demographics
NPI:1578865077
Name:GEORGIA CARDIOLOGY CENTER, LLC
Entity Type:Organization
Organization Name:GEORGIA CARDIOLOGY CENTER, LLC
Other - Org Name:GEORGIA CARDIOLOGY CENTER - WR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIRZA
Authorized Official - Middle Name:W
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-741-6400
Mailing Address - Street 1:PO BOX 4687
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-4687
Mailing Address - Country:US
Mailing Address - Phone:478-922-4626
Mailing Address - Fax:478-923-7769
Practice Address - Street 1:124 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-4204
Practice Address - Country:US
Practice Address - Phone:478-922-4626
Practice Address - Fax:478-923-7769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site