1336432558 NPI number — PARIS HEART AND VASCULAR CARE, P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336432558 NPI number — PARIS HEART AND VASCULAR CARE, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARIS HEART AND VASCULAR CARE, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336432558
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1780 OCONEE SPRINGS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STATHAM
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30666-3618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-519-4225
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2850 LEWIS LN
Provider Second Line Business Practice Location Address:
PAVILION 1, SUITE 114
Provider Business Practice Location Address City Name:
PARIS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75460-9383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-519-4225
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/20/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KIM
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
770-202-5003

Provider Taxonomy Codes

  • Taxonomy code: 261QR0404X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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