Healthcare Provider Details

I. General information

NPI: 1073338703
Provider Name (Legal Business Name): GASTROENTEROLOGY ASSOCIATES OF GAINESVILLE, P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2324 LIMESTONE OVERLOOK STE D101 SUITE D101
GAINESVILLE GA
30501-7443
US

IV. Provider business mailing address

PO BOX 907790
GAINESVILLE GA
30501-0912
US

V. Phone/Fax

Practice location:
  • Phone: 770-536-8109
  • Fax:
Mailing address:
  • Phone: 770-536-8109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: CHELSEY EDELBERG
Title or Position: CLINICAL MANAGER
Credential:
Phone: 678-997-2121