Provider Demographics
NPI:1578694899
Name:DIGESTIVE & LIVER SPECIALIST, P.C.
Entity Type:Organization
Organization Name:DIGESTIVE & LIVER SPECIALIST, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MIRZA
Authorized Official - Middle Name:A
Authorized Official - Last Name:KAJANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-251-2300
Mailing Address - Street 1:58 HOSPITAL RD
Mailing Address - Street 2:SUITE # 105
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30263-1230
Mailing Address - Country:US
Mailing Address - Phone:770-251-2300
Mailing Address - Fax:770-251-1361
Practice Address - Street 1:58 HOSPITAL RD
Practice Address - Street 2:SUITE # 105
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30263-1230
Practice Address - Country:US
Practice Address - Phone:770-251-2300
Practice Address - Fax:770-251-1361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA31955207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTAX I.D.
GAE82017Medicare UPIN
GA=========OtherTAX I.D.