Provider Demographics
NPI:1780011668
Name:SHOALS GASTROENTEROLOGY LLC
Entity Type:Organization
Organization Name:SHOALS GASTROENTEROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ABHINANDANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANANTHARAJU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-381-6304
Mailing Address - Street 1:PO BOX 298
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35631-0298
Mailing Address - Country:US
Mailing Address - Phone:256-767-7494
Mailing Address - Fax:256-765-0377
Practice Address - Street 1:1120 S JACKSON HWY
Practice Address - Street 2:SUITE 201
Practice Address - City:SHEFFIELD
Practice Address - State:AL
Practice Address - Zip Code:35660-5777
Practice Address - Country:US
Practice Address - Phone:256-381-6304
Practice Address - Fax:256-381-6307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-08
Last Update Date:2013-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty