Organization
PREMIER CARDIOTHORACIC SURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FADY WANNA (M.D.)
(478) 955-1804
Entity
Organization
Contact information
Practice address
688 WALNUT ST, SUITE 102, MACON, GA 31201-2677
(478) 955-1804
Mailing address
688 WALNUT ST, SUITE 102, MACON, GA 31201-2677
(478) 955-1804
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
043813
GA
Other
Enumeration date
03/24/2017
Last updated
03/24/2017
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