Provider Demographics
NPI:1801975339
Name:GASTROINTESTINAL SPECIALIST OF GEORGIA
Entity type:Organization
Organization Name:GASTROINTESTINAL SPECIALIST OF GEORGIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARIF
Authorized Official - Middle Name:
Authorized Official - Last Name:AZIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-741-2317
Mailing Address - Street 1:711 CANTON RD NE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-8948
Mailing Address - Country:US
Mailing Address - Phone:678-741-5000
Mailing Address - Fax:770-944-4522
Practice Address - Street 1:711 CANTON RD NE
Practice Address - Street 2:SUITE 300
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-8948
Practice Address - Country:US
Practice Address - Phone:678-741-5000
Practice Address - Fax:770-944-4522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300031375AMedicaid
GA300031375AMedicaid