Healthcare Provider Details

I. General information

NPI: 1659627131
Provider Name (Legal Business Name): PHOEBE GASTROENTEROLOGY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2012
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2740 RAY KNIGHT WAY STE 100
ALBANY GA
31707-0226
US

IV. Provider business mailing address

2740 RAY KNIGHT WAY STE 100
ALBANY GA
31707-0226
US

V. Phone/Fax

Practice location:
  • Phone: 229-312-0669
  • Fax:
Mailing address:
  • Phone: 229-312-0669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROBERT LAGESSE
Title or Position: SR VP PHYSICIAN SERVICES
Credential:
Phone: 229-312-1000