Provider Demographics
NPI:1710080973
Name:DIGESTIVE HEALTH ASSOCIATES, PC
Entity Type:Organization
Organization Name:DIGESTIVE HEALTH ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAY
Authorized Official - Middle Name:P
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-698-8101
Mailing Address - Street 1:2515 DESALES AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-1100
Mailing Address - Country:US
Mailing Address - Phone:423-698-8101
Mailing Address - Fax:423-698-3450
Practice Address - Street 1:2515 DESALES AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1100
Practice Address - Country:US
Practice Address - Phone:423-698-8101
Practice Address - Fax:423-698-3450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20740207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1932181245OtherNPI FOR DONALD HETZEL, MD
TN103I502664OtherTN MEDICARE SHANNON FAIRES
1649558081OtherNPI DESTIN GRIFFIN TRUSSELL
1316226616OtherNPI SHANNON FAIRES
TN1538141411OtherNPI FOR JAMES S MANTON MD
TN1558343434OtherNPI FOR VIJAY PATEL, MD
TN103I502665OtherMEDICARE DESTIN GRIFFIN TRUSSELL
TN3723922Medicaid
TN3052531Medicare ID - Type UnspecifiedVIJAY PATEL, MD TN MCARE
TNF22939Medicare UPIN
TN3723922Medicaid
1649558081OtherNPI DESTIN GRIFFIN TRUSSELL
TN1558343434OtherNPI FOR VIJAY PATEL, MD
1316226616OtherNPI SHANNON FAIRES
TNG67410Medicare UPIN