Provider Demographics
NPI:1225452931
Name:DIGESTIVE HEALTHCARE OF GA, P.C.
Entity Type:Organization
Organization Name:DIGESTIVE HEALTHCARE OF GA, P.C.
Other - Org Name:DIGESTIVE HEALTHCARE OF GA BLUE RIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:MONIQUE
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-603-3543
Mailing Address - Street 1:101 RIVERSTONE VIS
Mailing Address - Street 2:SUITE 217
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513-6648
Mailing Address - Country:US
Mailing Address - Phone:706-632-8008
Mailing Address - Fax:706-632-8070
Practice Address - Street 1:95 COLLIER ROAD
Practice Address - Street 2:SUITE 4075
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1751
Practice Address - Country:US
Practice Address - Phone:404-603-3543
Practice Address - Fax:404-350-8795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207RG0100X174400000X
GA207R0000X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty