Provider Demographics
NPI:1912165382
Name:MERVYN B FORMAN MD, L.L.C
Entity Type:Organization
Organization Name:MERVYN B FORMAN MD, L.L.C
Other - Org Name:CARDIOVASCULAR ASSOCIATES OF SANDY SPRINGS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MERVYN
Authorized Official - Middle Name:B
Authorized Official - Last Name:FORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-446-1900
Mailing Address - Street 1:960 JOHNSON FERRY RD NE
Mailing Address - Street 2:STE 530
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1631
Mailing Address - Country:US
Mailing Address - Phone:404-446-1900
Mailing Address - Fax:
Practice Address - Street 1:960 JOHNSON FERRY RD NE
Practice Address - Street 2:STE 530
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1631
Practice Address - Country:US
Practice Address - Phone:404-446-1900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035873207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty