Provider Demographics
NPI:1700087905
Name:CAMDEN DIGESTIVE DISEASES
Entity Type:Organization
Organization Name:CAMDEN DIGESTIVE DISEASES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VANTUIL
Authorized Official - Middle Name:L
Authorized Official - Last Name:VARGES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-882-2167
Mailing Address - Street 1:96B LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:GA
Mailing Address - Zip Code:31558-3851
Mailing Address - Country:US
Mailing Address - Phone:912-882-2167
Mailing Address - Fax:912-882-2169
Practice Address - Street 1:96B LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:GA
Practice Address - Zip Code:31558-3851
Practice Address - Country:US
Practice Address - Phone:912-882-2167
Practice Address - Fax:912-882-2169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA39689174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP6548Medicare ID - Type Unspecified
GAC59261Medicare UPIN