Provider Demographics
NPI:1750025425
Name:GASTROENTEROLOGY PHYSICIAN SERVICES LLC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY PHYSICIAN SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHANE
Authorized Official - Middle Name:B
Authorized Official - Last Name:DARRAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-243-4500
Mailing Address - Street 1:PO BOX 8629
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-8629
Mailing Address - Country:US
Mailing Address - Phone:706-655-8800
Mailing Address - Fax:706-940-4764
Practice Address - Street 1:2200 HAMILTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8855
Practice Address - Country:US
Practice Address - Phone:706-655-8800
Practice Address - Fax:706-940-4764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-27
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Multi-Specialty