Provider Demographics
NPI:1659627131
Name:PHOEBE GASTROENTEROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:PHOEBE GASTROENTEROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR VP PHYSICIAN SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LAGESSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-312-1000
Mailing Address - Street 1:2740 RAY KNIGHT WAY
Mailing Address - Street 2:STE 100
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31707-0226
Mailing Address - Country:US
Mailing Address - Phone:229-312-0669
Mailing Address - Fax:
Practice Address - Street 1:2740 RAY KNIGHT WAY
Practice Address - Street 2:STE 100
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-0226
Practice Address - Country:US
Practice Address - Phone:229-312-0669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHOEBE PHYSICIAN GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center