Provider Demographics
NPI:1730662750
Name:TWIN ARRHYTHMIA GROUP, LLC
Entity Type:Organization
Organization Name:TWIN ARRHYTHMIA GROUP, LLC
Other - Org Name:PHYSICIAN CLINIC OFFICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ONAJEFE
Authorized Official - Middle Name:S
Authorized Official - Last Name:NELSON-TWAKOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-338-9161
Mailing Address - Street 1:PO BOX 4163
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31208-4163
Mailing Address - Country:US
Mailing Address - Phone:478-338-9161
Mailing Address - Fax:478-259-1541
Practice Address - Street 1:770 PINE ST STE 200
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7513
Practice Address - Country:US
Practice Address - Phone:478-338-9161
Practice Address - Fax:478-259-1541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACARESOURCEOtherCS1712105106