NPIMap

Organization Active NPI

Cardiology Specialists of Georgia LLC

  • Cardiovascular Disease Physician
  • Tifton, GA
National Provider Identifier
1255364600
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
057762 Issued in GA
Legal business name
CARDIOLOGY SPECIALISTS OF GEORGIA LLC
Practice address
907 18TH St E
Suite 100
Tifton, GA 31794-3643
Phone
(229) 391-9980
Fax
(229) 391-9984
NPI assigned
Jul 9, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Michael Scott Fenster, M.D.
Title
Managing Partner
Phone
(229) 391-9980

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 057762 GA Primary

Addresses

Primary practice location

907 18TH St E
Suite 100
Tifton, GA 31794-3643

Mailing address

907 18TH St E
Suite 100
Tifton, GA 31794-3643
Phone (229) 391-9980

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1255364600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "907 18TH ST E",
            "address_2": "SUITE 100",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943643",
            "telephone_number": "229-391-9980",
            "fax_number": "229-391-9984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "907 18TH ST E",
            "address_2": "SUITE 100",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943643",
            "telephone_number": "229-391-9980",
            "fax_number": "229-391-9984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARDIOLOGY SPECIALISTS OF GEORGIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-09",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FENSTER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "SCOTT",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "229-391-9980",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "GA",
            "license": "057762",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tifton, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.