Cardiology Care Clinic, LLC
Organization Active NPI Cardiovascular Disease Physician · Eatonton, GA
NPI 1962764639 · NPPES record last updated Jul 27, 2020
Key facts
- NPI
- 1962764639
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Cardiovascular Disease Physician 207RC0000X
- Legal business name
- CARDIOLOGY CARE CLINIC, LLC
- Practice address
- 119 Harmony Xing Ste 3
Eatonton, GA 31024-9571 - Phone
- (706) 485-4004
- Fax
- (706) 262-2986
- NPI assigned
- Jun 8, 2012
- Organization subpart
- No
Authorized official
- Name
- Nicolas A.F. Chronos, MD
- Title
- Owner
- Phone
- (706) 485-4004
Practitioners 14
-
Peter D Chapman, MD
-
Amy Michelle Hayes, AGNP-C
-
Michelle M Lamm, AGNP-C
-
Susan Hardy Leighty, FNP-C
-
Eric K Silver, MD
-
Kimberly Goodwin Warnock, NP-C
-
Maureen Bowser, NP
-
Diane Peterman, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120725000273 | GA | Part B Supplier - Clinic/Group Practice | 4385800093 |
Receives reassigned benefits from 14 practitioners Practice locations: Eatonton, GA |
National Provider Directory
Locations
119 Harmony Xing
Eatonton, GA 31024
Phone (706) 485-4004
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker |
1041C0700X | |||
| Cardiovascular Disease Physician |
207RC0000X | Yes | ||
| Cardiac Rehabilitation Clinic/Center | 261QR0404X |
Addresses
Primary practice location
119 Harmony Xing Ste 3
Eatonton, GA 31024-9571
Mailing address
119 Harmony Xing Ste 3
Eatonton, GA 31024-9571
Phone (706) 485-4004
Other practice location 1
117 Harmony Xing Ste 1
Eatonton, GA 31024-9548
Phone (706) 485-4004
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003126643A | Medicaid | GA |
Other providers in Eatonton, GA
- Jenifer Byrd
- Beverly Jean Cadwallader
- Jennifer Maureen Carawan
- Cardiac Disease Specialists, PC
- Cardiology Care Clinic, LLC
- Caring Hearts Home Healthcare, LLC
- Timothy Charles Castellaw
- Melinda Beth Cathey
- Peter D Chapman
- Susan Exley Chapman
All providers in Eatonton, GA · Cardiovascular Disease Physician in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 27, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.