Provider Demographics
NPI:1679640353
Name:DIGESTIVE HEALTHCARE PC
Entity Type:Organization
Organization Name:DIGESTIVE HEALTHCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KWAME
Authorized Official - Middle Name:VIKRAM
Authorized Official - Last Name:CONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-817-0224
Mailing Address - Street 1:5900 HILLANDALE DR STE 330
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30058-3892
Mailing Address - Country:US
Mailing Address - Phone:770-817-0224
Mailing Address - Fax:770-817-0228
Practice Address - Street 1:5900 HILLANDALE DR STE 330
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058-3892
Practice Address - Country:US
Practice Address - Phone:770-817-0224
Practice Address - Fax:770-817-0228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty