Provider Demographics
NPI:1770962508
Name:TOTAL CARDIOLOGY OF ATLANTA
Entity type:Organization
Organization Name:TOTAL CARDIOLOGY OF ATLANTA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHAREE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEARHOLT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-995-5068
Mailing Address - Street 1:285 BOULEVARD NE STE 115
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-4207
Mailing Address - Country:US
Mailing Address - Phone:678-995-5068
Mailing Address - Fax:470-575-5849
Practice Address - Street 1:285 BOULEVARD NE STE 115
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-4207
Practice Address - Country:US
Practice Address - Phone:678-995-5068
Practice Address - Fax:470-575-5849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA059778207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA268085277FMedicaid