Provider Demographics
NPI:1518990472
Name:GASTROENTEROLOGY ASSOCIATES PC
Entity type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:AIMEE
Authorized Official - Middle Name:CATHLEEN
Authorized Official - Last Name:JUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-737-4665
Mailing Address - Street 1:65 GERMANTOWN CT
Mailing Address - Street 2:STE 300
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-4404
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:703-330-2923
Practice Address - Street 1:7915 LAKE MANASSAS DR STE 302
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3260
Practice Address - Country:US
Practice Address - Phone:571-248-0653
Practice Address - Fax:571-248-0658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101027526174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty