Provider Demographics
NPI:1851611651
Name:EAST ATLANTA CARDIOLOGY LLC
Entity Type:Organization
Organization Name:EAST ATLANTA CARDIOLOGY LLC
Other - Org Name:EAST ATLANTA CARDIOLOGY PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MD, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MUTHAYYAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SRINIVASAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-322-8881
Mailing Address - Street 1:5255 SNAPFINGER PARK DR
Mailing Address - Street 2:SUITE 130
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-4084
Mailing Address - Country:US
Mailing Address - Phone:770-322-8881
Mailing Address - Fax:770-322-8886
Practice Address - Street 1:5255 SNAPFINGER PARK DR
Practice Address - Street 2:SUITE 130
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-4084
Practice Address - Country:US
Practice Address - Phone:770-322-8881
Practice Address - Fax:770-322-8886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-03
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA52836261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty