Provider Demographics
NPI:1477870327
Name:DUBLIN GASTROENTEROLOGY ASSOC, LLC
Entity Type:Organization
Organization Name:DUBLIN GASTROENTEROLOGY ASSOC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-272-1366
Mailing Address - Street 1:PO BOX 1925
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31040-1925
Mailing Address - Country:US
Mailing Address - Phone:478-277-1255
Mailing Address - Fax:478-304-1467
Practice Address - Street 1:104 FAIRVIEW PARK DR
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2500
Practice Address - Country:US
Practice Address - Phone:478-277-1255
Practice Address - Fax:478-304-1467
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-30
Last Update Date:2015-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003109888AMedicaid
GA003109888AMedicaid