Provider Demographics
NPI:1609023761
Name:EMORY JOHNS CREEK CARDIAC DIAGNOSTICS
Entity Type:Organization
Organization Name:EMORY JOHNS CREEK CARDIAC DIAGNOSTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGLOIS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:678-957-9935
Mailing Address - Street 1:10700 MEDLOCK BRIDGE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-8456
Mailing Address - Country:US
Mailing Address - Phone:678-957-9935
Mailing Address - Fax:678-957-9954
Practice Address - Street 1:10700 MEDLOCK BRIDGE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-8456
Practice Address - Country:US
Practice Address - Phone:678-957-9935
Practice Address - Fax:678-957-9954
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EHCA JOHNS CREEK HOLDINGS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-08-20
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0800003824261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G470017OtherMEDICARE BILLING NUMBER