Provider Demographics
NPI:1053344341
Name:CARDIOVASCULAR ASSOCIATES OF AUGUSTA, PA
Entity type:Organization
Organization Name:CARDIOVASCULAR ASSOCIATES OF AUGUSTA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAY
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-724-8611
Mailing Address - Street 1:1348 WALTON WAY
Mailing Address - Street 2:SUITE 5100
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901
Mailing Address - Country:US
Mailing Address - Phone:706-724-8611
Mailing Address - Fax:706-821-8110
Practice Address - Street 1:1348 WALTON WAY
Practice Address - Street 2:SUITE 5100
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901
Practice Address - Country:US
Practice Address - Phone:706-724-8611
Practice Address - Fax:706-821-8110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017835207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty