Provider Demographics
NPI:1518250414
Name:GEORGIA GASTROENTEROLOGY,LLC.
Entity Type:Organization
Organization Name:GEORGIA GASTROENTEROLOGY,LLC.
Other - Org Name:GEORGIA GASTROENTEROLOGY,LLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
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:803-226-0073
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:803-226-0073
Mailing Address - Fax:803-226-0074
Practice Address - Street 1:35 VARDEN DR
Practice Address - Street 2:SUITE C
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803
Practice Address - Country:US
Practice Address - Phone:706-922-7777
Practice Address - Fax:706-922-7780
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GEORGIA GASTROENTEROLOGY,LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-25
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC26590207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG44896Medicaid
SC9149Medicare PIN
GAH44491Medicare UPIN