Provider Demographics
NPI:1649547068
Name:AHP - GASTRO GAINESVILLE, LLC
Entity type:Organization
Organization Name:AHP - GASTRO GAINESVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRES.
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-536-8109
Mailing Address - Street 1:3079 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-2215
Mailing Address - Country:US
Mailing Address - Phone:770-945-5330
Mailing Address - Fax:877-820-4154
Practice Address - Street 1:660 LANIER PARK DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2075
Practice Address - Country:US
Practice Address - Phone:770-536-8109
Practice Address - Fax:678-997-2127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty