Provider Demographics
NPI:1760576656
Name:ATLANTA HEART GROUP PC
Entity Type:Organization
Organization Name:ATLANTA HEART GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIRSCHBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-297-9077
Mailing Address - Street 1:2665 N DECATUR ROAD
Mailing Address - Street 2:SUITE 260
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-6145
Mailing Address - Country:US
Mailing Address - Phone:404-297-9077
Mailing Address - Fax:404-296-1220
Practice Address - Street 1:2665 N DECATUR ROAD
Practice Address - Street 2:SUITE 260
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-6145
Practice Address - Country:US
Practice Address - Phone:404-297-9077
Practice Address - Fax:404-296-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021728207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA055001136AMedicaid
GA055001136AMedicaid
GACB1551Medicare PIN