Provider Demographics
NPI:1972755650
Name:NORTH GEORGIA DIGESTIVE DISEASE CONSULTANTS, LLC
Entity Type:Organization
Organization Name:NORTH GEORGIA DIGESTIVE DISEASE CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BHUVANENDRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:INDRAKRISHNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-274-4180
Mailing Address - Street 1:2887 DARLINGTON RUN
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4315
Mailing Address - Country:US
Mailing Address - Phone:770-814-8414
Mailing Address - Fax:
Practice Address - Street 1:475 PHILIP BLVD
Practice Address - Street 2:304
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8737
Practice Address - Country:US
Practice Address - Phone:678-377-8252
Practice Address - Fax:336-553-3994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty