Provider Demographics
NPI:1639322779
Name:GREGORY A. DELAURIER, M.D., COLORECTAL AND GENERAL SURGERY, P.C.
Entity Type:Organization
Organization Name:GREGORY A. DELAURIER, M.D., COLORECTAL AND GENERAL SURGERY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:DELAURIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-546-7646
Mailing Address - Street 1:1500 OGLETHORPE AVE
Mailing Address - Street 2:SUITE 600F
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-2179
Mailing Address - Country:US
Mailing Address - Phone:706-546-7646
Mailing Address - Fax:706-546-7472
Practice Address - Street 1:1500 OGLETHORPE AVE
Practice Address - Street 2:SUITE 3600
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-2179
Practice Address - Country:US
Practice Address - Phone:706-546-7646
Practice Address - Fax:706-546-7472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA29625208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00655542CMedicaid
F21696Medicare UPIN
28BBBDKMedicare PIN