Organization
CARDIOVASCULAR GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARIAH WOOD THAXTON PA-C (PHYSICIAN ASSISTANT)
(478) 457-7128
Entity
Organization
Contact information
Practice address
755 WALTHER RD, LAWRENCEVILLE, GA 30046-8725
(678) 252-3707
Mailing address
1051 STONE SHOALS CT, WATKINSVILLE, GA 30677-2774
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/18/2009
Last updated
10/03/2012
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