Provider Demographics
NPI:1740238435
Name:ATLANTIC GASTROENTEROLOGY PA
Entity Type:Organization
Organization Name:ATLANTIC GASTROENTEROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:STURGIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-758-2424
Mailing Address - Street 1:2465 EMERALD PL
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-5785
Mailing Address - Country:US
Mailing Address - Phone:252-758-2424
Mailing Address - Fax:252-758-0424
Practice Address - Street 1:2465 EMERALD PL
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5785
Practice Address - Country:US
Practice Address - Phone:252-758-2424
Practice Address - Fax:252-758-0424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC017GFOtherBCBS GROUP NUMBER
NC5901778Medicaid
NC5901778Medicaid