Provider Demographics
NPI:1528192176
Name:GASTROENTEROLOGY ASSOCIATES OF CENTRAL GA, LLC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES OF CENTRAL GA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CROUCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-464-2600
Mailing Address - Street 1:610 3RD ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-3294
Mailing Address - Country:US
Mailing Address - Phone:478-464-2600
Mailing Address - Fax:478-464-2604
Practice Address - Street 1:610 3RD ST
Practice Address - Street 2:SUITE 206
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-3294
Practice Address - Country:US
Practice Address - Phone:478-464-2600
Practice Address - Fax:478-464-2604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADA4873OtherMEDICARE RAILRAOD
GAGRP6042Medicare PIN