1871281121 NPI number — KERI HEART INC

Table of content: (NPI 1871281121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871281121 NPI number — KERI HEART INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KERI HEART INC
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:
KERI HEART MEDICAL CENTER
Provider Other Organization Name Type Code:
3
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:
1871281121
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
879 CEDAR RIVER CT SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30067-3928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-843-5470
Provider Business Mailing Address Fax Number:
313-749-9118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8735 DUNWOODY PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATLANTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30350-2995
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-843-5470
Provider Business Practice Location Address Fax Number:
313-800-0149
Provider Enumeration Date:
04/25/2023

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
DESHONNA
Authorized Official Middle Name:
LAFAY
Authorized Official Title or Position:
DIRECTOR/OWNER
Authorized Official Telephone Number:
248-843-5470

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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