Provider Demographics
NPI:1023397460
Name:METRO ATLANTA GASTROENTEROLOGY, LLC
Entity Type:Organization
Organization Name:METRO ATLANTA GASTROENTEROLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-255-4333
Mailing Address - Street 1:5669 PEACHTREE DUNWOODY RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1786
Mailing Address - Country:US
Mailing Address - Phone:404-255-4333
Mailing Address - Fax:404-255-0601
Practice Address - Street 1:5669 PEACHTREE DUNWOODY RD
Practice Address - Street 2:SUITE 210
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1762
Practice Address - Country:US
Practice Address - Phone:404-255-4333
Practice Address - Fax:404-255-0601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty