Provider Demographics
NPI:1598916553
Name:CENTER FOR COLON AND DIGESTIVE CARE
Entity Type:Organization
Organization Name:CENTER FOR COLON AND DIGESTIVE CARE
Other - Org Name:NORTHSIDE MEDICAL SPECIALISTS, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:SWAFFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-704-9499
Mailing Address - Street 1:15 REINHARDT COLLEGE PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-5257
Mailing Address - Country:US
Mailing Address - Phone:770-704-9499
Mailing Address - Fax:770-704-9754
Practice Address - Street 1:14 SAMMY MCGHEE BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-7721
Practice Address - Country:US
Practice Address - Phone:706-692-6566
Practice Address - Fax:706-692-3896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-08
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046761174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty