Provider Demographics
NPI:1841402302
Name:CARDIOVASCULAR CONSULTANTS, P.C.
Entity Type:Organization
Organization Name:CARDIOVASCULAR CONSULTANTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:G
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-355-0070
Mailing Address - Street 1:4700 WATERS AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6220
Mailing Address - Country:US
Mailing Address - Phone:912-355-0070
Mailing Address - Fax:912-355-3220
Practice Address - Street 1:4700 WATERS AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6220
Practice Address - Country:US
Practice Address - Phone:912-355-0070
Practice Address - Fax:912-355-3220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP1578Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER