Provider Demographics
NPI:1639128531
Name:SOUTHERN HEART SPECIALISTS, P.C.
Entity Type:Organization
Organization Name:SOUTHERN HEART SPECIALISTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:FREIREICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-991-2100
Mailing Address - Street 1:6507 PROFESSIONAL PL
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-4941
Mailing Address - Country:US
Mailing Address - Phone:770-991-2100
Mailing Address - Fax:770-991-1180
Practice Address - Street 1:6507 PROFESSIONAL PL
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-4941
Practice Address - Country:US
Practice Address - Phone:770-991-2100
Practice Address - Fax:770-991-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2012-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA085000570GMedicaid
GAGRP1614OtherMEDICARE ID