Provider Demographics
NPI:1669655874
Name:GEORGIA THORACIC & CARDIOVASCULAR SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:GEORGIA THORACIC & CARDIOVASCULAR SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-904-5182
Mailing Address - Street 1:960 JOHNSON FERRY RD
Mailing Address - Street 2:SUITE 518
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342
Mailing Address - Country:US
Mailing Address - Phone:678-904-5182
Mailing Address - Fax:678-904-5186
Practice Address - Street 1:960 JOHNSON FERRY RD
Practice Address - Street 2:SUITE 518
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342
Practice Address - Country:US
Practice Address - Phone:678-904-5182
Practice Address - Fax:678-904-5186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037035174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP4787Medicare PIN