Provider Demographics
NPI:1861485914
Name:GEORGIA PEDIATRIC CARDIOLOGY
Entity Type:Organization
Organization Name:GEORGIA PEDIATRIC CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:W
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-289-1988
Mailing Address - Street 1:1045 SOUTHCREST DR
Mailing Address - Street 2:STE 220
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6113
Mailing Address - Country:US
Mailing Address - Phone:678-289-1988
Mailing Address - Fax:678-289-1512
Practice Address - Street 1:1045 SOUTHCREST DR
Practice Address - Street 2:STE 220
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6113
Practice Address - Country:US
Practice Address - Phone:678-289-1988
Practice Address - Fax:678-289-1512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2010-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty