Provider Demographics
NPI:1710027800
Name:CARDIAC DISEASE CONSULTANTS, LLC
Entity Type:Organization
Organization Name:CARDIAC DISEASE CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-890-3447
Mailing Address - Street 1:1 SWEET BAY CT STE B
Mailing Address - Street 2:
Mailing Address - City:MOULTRIE
Mailing Address - State:GA
Mailing Address - Zip Code:31768-6713
Mailing Address - Country:US
Mailing Address - Phone:229-890-5305
Mailing Address - Fax:229-890-5307
Practice Address - Street 1:1 SWEET BAY CT STE B
Practice Address - Street 2:
Practice Address - City:MOULTRIE
Practice Address - State:GA
Practice Address - Zip Code:31768-6713
Practice Address - Country:US
Practice Address - Phone:229-890-5305
Practice Address - Fax:229-890-5307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037415207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE22517Medicare UPIN
GA06BDJBJMedicare ID - Type Unspecified