# CARDIOVASCULAR GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003140351
- **Authorized official:** MRS. MARIAH WOOD THAXTON PA-C (PHYSICIAN ASSISTANT)
- **Authorized official phone:** (478) 457-7128

## Contact information

- **Practice address:** 755 WALTHER RD, LAWRENCEVILLE, GA 30046-8725
- **Practice address phone:** (678) 252-3707
- **Mailing address:** 1051 STONE SHOALS CT, WATKINSVILLE, GA 30677-2774

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363A00000X | Physician Assistant | — | — | Yes |

## Other

- **Enumeration date:** 09/18/2009
- **Last updated:** 10/03/2012