Basic Information
| Provider Information | |||||||||
| NPI: | 1891097473 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CARDIOLOGY PHYSICIANS CORPORATION, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 741483 | ||||||||
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| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303741483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283244804 | ||||||||
| FaxNumber: | 8283247256 | ||||||||
| Practice Location | |||||||||
| Address1: | 1771 TATE BLVD SE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | HICKORY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286024250 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283244804 | ||||||||
| FaxNumber: | 8283247256 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/02/2010 | ||||||||
| LastUpdateDate: | 05/26/2016 | ||||||||
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| AuthorizedOfficialLastName: | JAMES | ||||||||
| AuthorizedOfficialFirstName: | WESLEY | ||||||||
| AuthorizedOfficialMiddleName: | O. | ||||||||
| AuthorizedOfficialTitleorPosition: | REGIONAL CFO, TENET | ||||||||
| AuthorizedOfficialTelephone: | 4042655009 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.