Provider Demographics
NPI:1689707432
Name:AUGUSTA GASTROINTESTINAL SPECIALISTS INC
Entity Type:Organization
Organization Name:AUGUSTA GASTROINTESTINAL SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:706-722-1461
Mailing Address - Street 1:820 SAINT SEBASTIAN WAY
Mailing Address - Street 2:SUITE 2 D
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2643
Mailing Address - Country:US
Mailing Address - Phone:706-722-1461
Mailing Address - Fax:706-722-2767
Practice Address - Street 1:820 SAINT SEBASTIAN WAY
Practice Address - Street 2:SUITE 2 D
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2643
Practice Address - Country:US
Practice Address - Phone:706-722-1461
Practice Address - Fax:706-722-2767
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAG025517207RG0100X
GA048164207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GUG025517OtherLICENSE
GA1245277250OtherNPI
GAGRP4596OtherMEDICARE GROUP
GUGRP4596OtherMEDICARE GROUP
GA00918013AMedicaid
GA00283654BMedicaid
GU048164OtherLICENSE
GA1316984347OtherNPI
GUGRP4596OtherMEDICARE GROUP
GAGRP4596OtherMEDICARE GROUP
GA1316984347OtherNPI
GA00283654BMedicaid