Healthcare Provider Details

I. General information

NPI: 1063698900
Provider Name (Legal Business Name): DIGESTIVE CARE SPECIALIST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2008
Last Update Date: 03/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 NORTHSIDE BLVD
CUMMING GA
30041
US

IV. Provider business mailing address

1505 NORTHSIDE BLVD
CUMMING GA
30041
US

V. Phone/Fax

Practice location:
  • Phone: 770-227-2222
  • Fax: 770-227-2220
Mailing address:
  • Phone: 770-227-2222
  • Fax: 770-227-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number055299
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number055299
License Number StateGA

VIII. Authorized Official

Name: DR. RANVIR SINGH
Title or Position: OWNER/PHYSICIAN
Credential: MD
Phone: 770-227-2222