Provider Demographics
NPI:1598805707
Name:GEORGIA HEART AND LUNG ASSOCIATES PC
Entity Type:Organization
Organization Name:GEORGIA HEART AND LUNG ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:VINCENT
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-223-5551
Mailing Address - Street 1:315 BOULEVARD NE
Mailing Address - Street 2:310
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-1200
Mailing Address - Country:US
Mailing Address - Phone:404-223-5551
Mailing Address - Fax:404-223-0910
Practice Address - Street 1:315 BOULEVARD NE
Practice Address - Street 2:310
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1200
Practice Address - Country:US
Practice Address - Phone:404-223-5551
Practice Address - Fax:404-223-0910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032056208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00400551DMedicaid
GA1215939624OtherINDIVIDUAL NPI NUMBER
GAE59187Medicare UPIN
GA78BBBDZMedicare ID - Type Unspecified
GA1215939624OtherINDIVIDUAL NPI NUMBER