Healthcare Provider Details

I. General information

NPI: 1477712115
Provider Name (Legal Business Name): GEORGIA GASTROENTEROLOGY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2008
Last Update Date: 06/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 MAGNOLIA WAY SUITE 201
AUGUSTA GA
30909-9483
US

IV. Provider business mailing address

1701 MAGNOLIA WAY SUITE 201
AUGUSTA GA
30909-9483
US

V. Phone/Fax

Practice location:
  • Phone: 706-922-7777
  • Fax:
Mailing address:
  • Phone: 706-922-7777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number044896
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number044896
License Number StateGA

VIII. Authorized Official

Name: DR. AYAZ J. CHAUDHARY
Title or Position: OWNER
Credential: MD
Phone: 706-922-7777