Healthcare Provider Details

I. General information

NPI: 1780864256
Provider Name (Legal Business Name): METRO ATLANTA GASTROENTEROLOGY,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2007
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5669 PEACHTREE DUNWOODY RD NE STE 210
ATLANTA GA
30342-1762
US

IV. Provider business mailing address

5669 PEACHTREE DUNWOODY RD NE STE 210
ATLANTA GA
30342-1762
US

V. Phone/Fax

Practice location:
  • Phone: 404-255-4333
  • Fax:
Mailing address:
  • Phone: 404-255-4333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER LOVE
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 404-255-4333