Provider Demographics
NPI:1407969371
Name:PEDIATRIC GASTROENTEROLOGY ASSOCIATES PC
Entity Type:Organization
Organization Name:PEDIATRIC GASTROENTEROLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:LANEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:256-536-3832
Mailing Address - Street 1:303 WILLIAMS AVENUE
Mailing Address - Street 2:SUITE 1021
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801
Mailing Address - Country:US
Mailing Address - Phone:256-536-3832
Mailing Address - Fax:256-536-8829
Practice Address - Street 1:303 WILLIAMS AVENUE
Practice Address - Street 2:SUITE 1021
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-536-3832
Practice Address - Fax:256-536-8829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Multi-Specialty