Provider Demographics
NPI:1649441882
Name:CENTER FOR PREVENTATIVE CARDIOVASCULAR CARE PC
Entity type:Organization
Organization Name:CENTER FOR PREVENTATIVE CARDIOVASCULAR CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMRECAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-560-1400
Mailing Address - Street 1:1513 JOHNSON FERRY RD
Mailing Address - Street 2:SUITE 175
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8101
Mailing Address - Country:US
Mailing Address - Phone:678-560-1400
Mailing Address - Fax:678-560-1401
Practice Address - Street 1:1513 JOHNSON FERRY RD
Practice Address - Street 2:SUITE 175
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-8101
Practice Address - Country:US
Practice Address - Phone:678-560-1400
Practice Address - Fax:678-560-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-16
Last Update Date:2008-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty