Provider Demographics
NPI:1588609937
Name:CARDIOLOGY ASSOCIATES OF ATLANTA, P.C.
Entity Type:Organization
Organization Name:CARDIOLOGY ASSOCIATES OF ATLANTA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRASI
Authorized Official - Middle Name:
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-223-1349
Mailing Address - Street 1:315 BOULEVARD NE STE 555
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1266
Mailing Address - Country:US
Mailing Address - Phone:404-223-1349
Mailing Address - Fax:404-223-3640
Practice Address - Street 1:315 BOULEVARD NE STE 555
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1266
Practice Address - Country:US
Practice Address - Phone:404-223-1349
Practice Address - Fax:404-223-3640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6460Medicare UPIN
GA1588609937Medicare PIN
GAGRP6460Medicare ID - Type UnspecifiedGROUP NUMBER