Provider Demographics
NPI:1336104280
Name:MID-SOUTH GASTROENTEROLOGY ASSOC PC
Entity Type:Organization
Organization Name:MID-SOUTH GASTROENTEROLOGY ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN CORP
Authorized Official - Prefix:
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHOKSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-388-8302
Mailing Address - Street 1:1222 TROTWOOD AVE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:COLUMBIA
Mailing Address - State:TN
Mailing Address - Zip Code:38401-6436
Mailing Address - Country:US
Mailing Address - Phone:931-388-8302
Mailing Address - Fax:931-388-9540
Practice Address - Street 1:1222 TROTWOOD AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:COLUMBIA
Practice Address - State:TN
Practice Address - Zip Code:38401-6436
Practice Address - Country:US
Practice Address - Phone:931-388-8302
Practice Address - Fax:931-388-9540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3702673Medicaid
TN3702673Medicaid