Provider Demographics
NPI:1104017607
Name:GI CONSULTANTS, PC
Entity Type:Organization
Organization Name:GI CONSULTANTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACKLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-629-6258
Mailing Address - Street 1:721 GLENWOOD DR
Mailing Address - Street 2:STE. W552
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1106
Mailing Address - Country:US
Mailing Address - Phone:423-629-6258
Mailing Address - Fax:423-629-9531
Practice Address - Street 1:721 GLENWOOD DR
Practice Address - Street 2:STE. W552
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1106
Practice Address - Country:US
Practice Address - Phone:423-629-6258
Practice Address - Fax:423-629-9531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11215207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3388156Medicaid
GA00170475BMedicaid
TNB59328Medicare UPIN
GA00170475BMedicaid