Provider Demographics
NPI:1659313153
Name:CENTRAL GEORGIA HEART INSTITUE, LLC
Entity Type:Organization
Organization Name:CENTRAL GEORGIA HEART INSTITUE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:SANDERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-293-4739
Mailing Address - Street 1:1707 WATSON BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-3606
Mailing Address - Country:US
Mailing Address - Phone:478-929-8030
Mailing Address - Fax:478-929-8095
Practice Address - Street 1:1707 WATSON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-3607
Practice Address - Country:US
Practice Address - Phone:478-929-8030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2022-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051049207R00000X
GA049348207R00000X
GA047951207R00000X
GA041593207RC0000X, 207RC0000X
GA052467207RP1001X, 207RS0012X, 207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP6832Medicare ID - Type Unspecified