Provider Demographics
NPI:1689885253
Name:MIDDLE GEORGIA GASTROENTEROLOGY
Entity Type:Organization
Organization Name:MIDDLE GEORGIA GASTROENTEROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:EBANKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-755-0800
Mailing Address - Street 1:791 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2045
Mailing Address - Country:US
Mailing Address - Phone:478-755-0800
Mailing Address - Fax:478-755-0807
Practice Address - Street 1:791 POPLAR ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2045
Practice Address - Country:US
Practice Address - Phone:478-755-0800
Practice Address - Fax:478-755-0807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty