Provider Demographics
NPI:1700047164
Name:CAROLINA GASTROENTEROLOGY CONSULTANTS, PLLC
Entity Type:Organization
Organization Name:CAROLINA GASTROENTEROLOGY CONSULTANTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEEGAR
Authorized Official - Middle Name:A
Authorized Official - Last Name:JAILWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-349-5223
Mailing Address - Street 1:459 E PALMER ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28734-3044
Mailing Address - Country:US
Mailing Address - Phone:828-369-5223
Mailing Address - Fax:
Practice Address - Street 1:459 E PALMER ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-3044
Practice Address - Country:US
Practice Address - Phone:828-369-5223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC01594174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG00222Medicare UPIN