Provider Demographics
NPI:1932245206
Name:AUGUSTA PREVENTIVE CARDIOLOGY
Entity Type:Organization
Organization Name:AUGUSTA PREVENTIVE CARDIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-731-9119
Mailing Address - Street 1:PO BOX 3545
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30914-3545
Mailing Address - Country:US
Mailing Address - Phone:706-868-0131
Mailing Address - Fax:706-854-0131
Practice Address - Street 1:1511 ANTHONY RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4821
Practice Address - Country:US
Practice Address - Phone:706-731-9119
Practice Address - Fax:706-731-9800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011846207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC904301Medicaid
GA00098788CMedicaid
GA00098788CMedicaid