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Organization

CARDIOLOGY ASSOCIATES OF VIDALIA, P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. ELAINE GILES (OFFICE MANAGER)
(912) 537-1221
Entity
Organization

Contact information

Practice address
1006 MOUNT VERNON RD, VIDALIA, GA 30474-3029
(912) 537-1221
(912) 537-1012
Mailing address
1006 MOUNT VERNON RD, VIDALIA, GA 30474-3029
(912) 537-1221
(912) 537-1012

Taxonomy

Speciality
Code
Description
License number
State
207RI0011X
Interventional Cardiology Physician
Primary
025159
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000348169R
GA
01
060062628
RAILROAD MEDICARE
GA
01
1104827369
NPI - INDIVIDUAL
GA
01
252783403
TRICARE
GA
Enumeration date
10/19/2007
Last updated
04/20/2015
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