Provider Demographics
NPI:1447301635
Name:PREMIER CARDIOLOGY GROUP
Entity type:Organization
Organization Name:PREMIER CARDIOLOGY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HISHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HAWASLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-762-6140
Mailing Address - Street 1:1136 CLEVELAND AVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3618
Mailing Address - Country:US
Mailing Address - Phone:404-762-6140
Mailing Address - Fax:404-762-7922
Practice Address - Street 1:1136 CLEVELAND AVE
Practice Address - Street 2:SUITE 410
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3618
Practice Address - Country:US
Practice Address - Phone:404-762-6140
Practice Address - Fax:404-762-7922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP1239Medicare ID - Type Unspecified