Provider Demographics
NPI:1982940987
Name:SOUTHEASTERN CARDIOVASCULAR ASSOCIATES LLC
Entity type:Organization
Organization Name:SOUTHEASTERN CARDIOVASCULAR ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:B
Authorized Official - Last Name:CHAPPELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-871-7810
Mailing Address - Street 1:1076 BERMUDA RUN
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0858
Mailing Address - Country:US
Mailing Address - Phone:912-871-7810
Mailing Address - Fax:912-871-7820
Practice Address - Street 1:1076 BERMUDA RUN
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0858
Practice Address - Country:US
Practice Address - Phone:912-871-7810
Practice Address - Fax:912-871-7820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty