Healthcare Provider Details

I. General information

NPI: 1861496564
Provider Name (Legal Business Name): DIGESTIVE HEALTHCARE OF GEORGIA ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3280 HOWELL MILL RD NW STE T150
ATLANTA GA
30327-4111
US

IV. Provider business mailing address

3280 HOWELL MILL RD NW STE T150
ATLANTA GA
30327-4111
US

V. Phone/Fax

Practice location:
  • Phone: 404-603-3543
  • Fax: 404-350-8795
Mailing address:
  • Phone: 404-603-3543
  • Fax: 404-350-8795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number060155
License Number StateGA

VIII. Authorized Official

Name: SHELLY M ROBINSON
Title or Position: DIRECTOR OF NCIS
Credential:
Phone: 404-603-3543