Provider Demographics
NPI:1356530901
Name:CARDIOLOGY ASSOCIATES OF VIDALIA, P.C.
Entity type:Organization
Organization Name:CARDIOLOGY ASSOCIATES OF VIDALIA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:GILES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-537-1221
Mailing Address - Street 1:1006 MOUNT VERNON RD
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-3029
Mailing Address - Country:US
Mailing Address - Phone:912-537-1221
Mailing Address - Fax:912-537-1012
Practice Address - Street 1:1006 MOUNT VERNON RD
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-3029
Practice Address - Country:US
Practice Address - Phone:912-537-1221
Practice Address - Fax:912-537-1012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025159207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000348169RMedicaid
GA252783403OtherTRICARE
GA060062628OtherRAILROAD MEDICARE
GA1104827369OtherNPI - INDIVIDUAL
GA252783403OtherTRICARE
GA1104827369OtherNPI - INDIVIDUAL