Provider Demographics
NPI:1306980578
Name:CARDIAC DISEASE SPECIALISTS, PC
Entity type:Organization
Organization Name:CARDIAC DISEASE SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BRESLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-355-9815
Mailing Address - Street 1:275 COLLIER RD NW
Mailing Address - Street 2:STE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1704
Mailing Address - Country:US
Mailing Address - Phone:404-355-9815
Mailing Address - Fax:404-603-7222
Practice Address - Street 1:1230 JOHNSON FERRY PL
Practice Address - Street 2:STE A10
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2048
Practice Address - Country:US
Practice Address - Phone:678-560-0511
Practice Address - Fax:404-350-0529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP595Medicare UPIN