Provider Demographics
NPI:1700076346
Name:ATLANTA SOUTH GASTROENTEROLOGY P.C.
Entity Type:Organization
Organization Name:ATLANTA SOUTH GASTROENTEROLOGY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-763-1606
Mailing Address - Street 1:1136 CLEVELAND AVE
Mailing Address - Street 2:SUITE 608
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3618
Mailing Address - Country:US
Mailing Address - Phone:404-763-1606
Mailing Address - Fax:404-768-3505
Practice Address - Street 1:1136 CLEVELAND AVE
Practice Address - Street 2:SUITE 608
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3618
Practice Address - Country:US
Practice Address - Phone:404-763-1606
Practice Address - Fax:404-768-3505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP1863Medicare PIN