Provider Demographics
NPI:1295872935
Name:ATLANTA THORACIC AND CARDIOVASCULAR SURGERY
Entity type:Organization
Organization Name:ATLANTA THORACIC AND CARDIOVASCULAR SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAEID
Authorized Official - Middle Name:
Authorized Official - Last Name:KHANSARINIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-603-9100
Mailing Address - Street 1:95 COLLIER RD NW
Mailing Address - Street 2:SUITE 4025
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1796
Mailing Address - Country:US
Mailing Address - Phone:404-603-9100
Mailing Address - Fax:404-603-9155
Practice Address - Street 1:95 COLLIER RD NW
Practice Address - Street 2:SUITE 4025
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1796
Practice Address - Country:US
Practice Address - Phone:404-603-9100
Practice Address - Fax:404-603-9155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA50649208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP7279Medicare ID - Type Unspecified