Provider Demographics
NPI:1750689964
Name:GI NORTH PC
Entity Type:Organization
Organization Name:GI NORTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/M.D.
Authorized Official - Prefix:
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:COFRANCESCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-446-0600
Mailing Address - Street 1:1505 NORTHSIDE BLVD
Mailing Address - Street 2:SUITE 1800
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041
Mailing Address - Country:US
Mailing Address - Phone:404-446-0600
Mailing Address - Fax:404-446-0601
Practice Address - Street 1:1505 NORTHSIDE BLVD
Practice Address - Street 2:SUITE 1800
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041
Practice Address - Country:US
Practice Address - Phone:404-446-0600
Practice Address - Fax:404-446-0601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA062826207RG0100X
207RG0100X, 207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic PathologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPENDINGMedicaid
GA62826OtherMEDICAL LICENSE
GAPENDINGMedicare PIN