Provider Demographics
NPI:1790773232
Name:NORTH GEORGIA CARDIOLOGY PC
Entity Type:Organization
Organization Name:NORTH GEORGIA CARDIOLOGY PC
Other - Org Name:COMMERCE CARDIOLOGY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NARASIMHULU
Authorized Official - Middle Name:
Authorized Official - Last Name:NEELAGARU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-335-2000
Mailing Address - Street 1:PO BOX 359
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-0007
Mailing Address - Country:US
Mailing Address - Phone:706-335-2000
Mailing Address - Fax:706-335-9593
Practice Address - Street 1:170 CARDIOLOGY PL
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-1083
Practice Address - Country:US
Practice Address - Phone:706-335-2000
Practice Address - Fax:706-335-9593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031081207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACL9489OtherPALMETTO GBA - RAILROAD MEDICARE
127526223AMedicare ID - Type Unspecified
GACL9489OtherPALMETTO GBA - RAILROAD MEDICARE