Provider Demographics
NPI:1780864256
Name:METRO ATLANTA GASTROENTEROLOGY,LLC
Entity Type:Organization
Organization Name:METRO ATLANTA GASTROENTEROLOGY,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-255-4333
Mailing Address - Street 1:5669 PEACHTREE DUNWOODY RD NE STE 210
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1762
Mailing Address - Country:US
Mailing Address - Phone:404-255-4333
Mailing Address - Fax:
Practice Address - Street 1:5669 PEACHTREE DUNWOODY RD NE STE 210
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1762
Practice Address - Country:US
Practice Address - Phone:404-255-4333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty