Provider Demographics
NPI:1376569467
Name:GASTROENTEROLOGY SPECIALISTS OF AUGUSTA, PC
Entity type:Organization
Organization Name:GASTROENTEROLOGY SPECIALISTS OF AUGUSTA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMZI
Authorized Official - Middle Name:T
Authorized Official - Last Name:ASSAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-860-6030
Mailing Address - Street 1:PO BOX 14220
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30919-0220
Mailing Address - Country:US
Mailing Address - Phone:706-860-6030
Mailing Address - Fax:706-868-8507
Practice Address - Street 1:1265 INTERSTATE PKWY # A
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6481
Practice Address - Country:US
Practice Address - Phone:706-860-6030
Practice Address - Fax:706-868-8507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP2051Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER