Provider Demographics
NPI:1790870624
Name:CARDIAC DISEASE SPECIALISTS, PC
Entity Type:Organization
Organization Name:CARDIAC DISEASE SPECIALISTS, PC
Other - Org Name:CARDIAC DISEASE SPECIALISTS, PC-EATONTON
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HARVEY
Authorized Official - Middle Name:N
Authorized Official - Last Name:SACKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-355-9815
Mailing Address - Street 1:275 COLLIER RD NW
Mailing Address - Street 2:STE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1704
Mailing Address - Country:US
Mailing Address - Phone:404-355-9815
Mailing Address - Fax:404-350-0529
Practice Address - Street 1:101 LAKE OCONEE PKWY
Practice Address - Street 2:SPECIALITY CENTER
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-6054
Practice Address - Country:US
Practice Address - Phone:706-485-0907
Practice Address - Fax:706-485-9006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP595Medicare ID - Type Unspecified