Provider Demographics
NPI:1376935023
Name:GASTROENTEROLOGY & HEPATOLOGY SPECIALISTS, LLC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY & HEPATOLOGY SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:
Authorized Official - First Name:LONG
Authorized Official - Middle Name:BAO
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:770-557-8788
Mailing Address - Street 1:1670 MCKENDREE CHURCH RD
Mailing Address - Street 2:#800
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-4107
Mailing Address - Country:US
Mailing Address - Phone:470-210-7766
Mailing Address - Fax:470-210-7767
Practice Address - Street 1:1670 MCKENDREE CHURCH RD
Practice Address - Street 2:#800
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-4107
Practice Address - Country:US
Practice Address - Phone:470-210-7766
Practice Address - Fax:470-210-7767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA14006863261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty