1649441882 NPI number — CENTER FOR PREVENTATIVE CARDIOVASCULAR CARE PC

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 1649441882 NPI number — CENTER FOR PREVENTATIVE CARDIOVASCULAR CARE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR PREVENTATIVE CARDIOVASCULAR CARE PC
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:
1649441882
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1513 JOHNSON FERRY RD
Provider Second Line Business Mailing Address:
SUITE 175
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30062-8101
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-560-1400
Provider Business Mailing Address Fax Number:
678-560-1401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1513 JOHNSON FERRY RD
Provider Second Line Business Practice Location Address:
SUITE 175
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30062-8101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-560-1400
Provider Business Practice Location Address Fax Number:
678-560-1401
Provider Enumeration Date:
03/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SMRECAK
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
678-560-1400

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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