Healthcare Provider Details

I. General information

NPI: 1225452931
Provider Name (Legal Business Name): DIGESTIVE HEALTHCARE OF GA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2014
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1665 HIGHWAY 34 E
NEWNAN GA
30265-2403
US

IV. Provider business mailing address

101 RIVERSTONE VIS SUITE 217
BLUE RIDGE GA
30513-6648
US

V. Phone/Fax

Practice location:
  • Phone: 404-603-3543
  • Fax: 404-350-8795
Mailing address:
  • Phone: 706-632-8008
  • Fax: 706-632-8070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number207R0000X
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number207RG0100X
License Number StateGA

VIII. Authorized Official

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