Provider Demographics
NPI:1689728636
Name:GEORGIA HEART CARE, LLC
Entity Type:Organization
Organization Name:GEORGIA HEART CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YITZHAK
Authorized Official - Middle Name:ISAAC
Authorized Official - Last Name:HERMONI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-886-0003
Mailing Address - Street 1:1200 BALD RIDGE MARINA RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-8494
Mailing Address - Country:US
Mailing Address - Phone:770-886-0003
Mailing Address - Fax:770-886-5030
Practice Address - Street 1:1200 BALD RIDGE MARINA RD
Practice Address - Street 2:SUITE 150
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-8494
Practice Address - Country:US
Practice Address - Phone:770-886-0003
Practice Address - Fax:770-886-5030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033352174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAA82238Medicare UPIN
GAP99313Medicare UPIN
GA97WCGDNMedicare ID - Type UnspecifiedPHYS ASST MEDICARE ID#
GA06BDFMMMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER