Provider Demographics
NPI:1962764639
Name:CARDIOLOGY CARE CLINIC, LLC
Entity type:Organization
Organization Name:CARDIOLOGY CARE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLAS
Authorized Official - Middle Name:AF
Authorized Official - Last Name:CHRONOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-485-4004
Mailing Address - Street 1:119 HARMONY XING STE 3
Mailing Address - Street 2:
Mailing Address - City:EATONTON
Mailing Address - State:GA
Mailing Address - Zip Code:31024-9571
Mailing Address - Country:US
Mailing Address - Phone:706-485-4004
Mailing Address - Fax:706-292-2986
Practice Address - Street 1:119 HARMONY XING STE 3
Practice Address - Street 2:
Practice Address - City:EATONTON
Practice Address - State:GA
Practice Address - Zip Code:31024-9571
Practice Address - Country:US
Practice Address - Phone:706-485-4004
Practice Address - Fax:706-262-2986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QR0404XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Cardiac FacilitiesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003126643AMedicaid