Provider Demographics
NPI:1477712115
Name:GEORGIA GASTROENTEROLOGY LLC
Entity Type:Organization
Organization Name:GEORGIA GASTROENTEROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AYAZ
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHAUDHARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-922-7777
Mailing Address - Street 1:1701 MAGNOLIA WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-9483
Mailing Address - Country:US
Mailing Address - Phone:706-922-7777
Mailing Address - Fax:
Practice Address - Street 1:1701 MAGNOLIA WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-9483
Practice Address - Country:US
Practice Address - Phone:706-922-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-07
Last Update Date:2008-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044896207RG0100X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000898433CMedicaid
H44491Medicare UPIN
GA10BDHLMMedicare PIN