Provider Demographics
NPI:1043616279
Name:ATHENS DIGESTIVE HEALTHCARE ASSOCIATES
Entity Type:Organization
Organization Name:ATHENS DIGESTIVE HEALTHCARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASIF
Authorized Official - Middle Name:M
Authorized Official - Last Name:QADRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-850-4985
Mailing Address - Street 1:1360 CADUCEUS WAY BUILDING 300
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-7300
Mailing Address - Country:US
Mailing Address - Phone:706-850-4985
Mailing Address - Fax:706-850-4989
Practice Address - Street 1:1360 CADUCEUS WAY BUILDING 300
Practice Address - Street 2:SUITE 101
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-7300
Practice Address - Country:US
Practice Address - Phone:706-850-4985
Practice Address - Fax:706-850-4989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA060492174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA383103105Medicaid