Provider Demographics
NPI:1295749125
Name:CARDIOLOGY CENTER OF DALTON PC
Entity type:Organization
Organization Name:CARDIOLOGY CENTER OF DALTON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EZAD
Authorized Official - Middle Name:N
Authorized Official - Last Name:AHMAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-272-0272
Mailing Address - Street 1:1411 CHATTANOOGA AVE
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720
Mailing Address - Country:US
Mailing Address - Phone:706-272-0272
Mailing Address - Fax:706-272-0276
Practice Address - Street 1:1411 CHATTANOOGA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2673
Practice Address - Country:US
Practice Address - Phone:706-272-0272
Practice Address - Fax:706-272-0276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038162207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000653397DMedicaid
GAE50661Medicare UPIN
GA06BDGCNMedicare ID - Type Unspecified