1518250414 NPI number — GEORGIA GASTROENTEROLOGY,LLC.

Table of content: (NPI 1518250414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518250414 NPI number — GEORGIA GASTROENTEROLOGY,LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GEORGIA GASTROENTEROLOGY,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:
6
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:
1518250414
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 MAGNOLIA WAY
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
AUGUSTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30909-9483
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-226-0073
Provider Business Mailing Address Fax Number:
803-226-0074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 VARDEN DR
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
AIKEN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-922-7777
Provider Business Practice Location Address Fax Number:
706-922-7780
Provider Enumeration Date:
05/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
CHAUDHARY
Authorized Official First Name:
AYAZ
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
803-226-0073

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  26590 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: G44896 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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