Provider Demographics
NPI:1023252954
Name:GASTRO SPECIALISTS ENDOSCOPY CENTER, LLC
Entity type:Organization
Organization Name:GASTRO SPECIALISTS ENDOSCOPY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-294-8180
Mailing Address - Street 1:3292 MOUNTAIN DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-1102
Mailing Address - Country:US
Mailing Address - Phone:404-294-8180
Mailing Address - Fax:404-294-8180
Practice Address - Street 1:3292 MOUNTAIN DR
Practice Address - Street 2:SUITE A
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-1102
Practice Address - Country:US
Practice Address - Phone:404-294-8180
Practice Address - Fax:404-294-8188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy