Provider Demographics
NPI:1558365247
Name:DIGESTIVE HEALTHCARE OF GEORGIA
Entity Type:Organization
Organization Name:DIGESTIVE HEALTHCARE OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:PENNINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-603-3543
Mailing Address - Street 1:95 COLLIER RD NW
Mailing Address - Street 2:SUITE 4075
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1796
Mailing Address - Country:US
Mailing Address - Phone:404-603-3543
Mailing Address - Fax:404-350-8795
Practice Address - Street 1:95 COLLIER RD NW
Practice Address - Street 2:STE 4075
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1751
Practice Address - Country:US
Practice Address - Phone:404-603-3543
Practice Address - Fax:404-350-8795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039539207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP3101Medicare ID - Type Unspecified