1528192176 NPI number — GASTROENTEROLOGY ASSOCIATES OF CENTRAL GA, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528192176 NPI number — GASTROENTEROLOGY ASSOCIATES OF CENTRAL GA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GASTROENTEROLOGY ASSOCIATES OF CENTRAL GA, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528192176
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
610 3RD ST
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
MACON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31201-3294
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-464-2600
Provider Business Mailing Address Fax Number:
478-464-2604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
610 3RD ST
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
MACON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31201-3294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
478-464-2600
Provider Business Practice Location Address Fax Number:
478-464-2604
Provider Enumeration Date:
03/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CROUCH
Authorized Official First Name:
ANGIE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
478-464-2600

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DA4873 . This is a "MEDICARE RAILRAOD" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com