Healthcare Provider Details

I. General information

NPI: 1841670817
Provider Name (Legal Business Name): GASTROINTESTINAL ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2015
Last Update Date: 09/17/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 LAKELAND DR. SUITE 150
FLOWOOD MS
39232
US

IV. Provider business mailing address

1620 W. NORTHWEST HIGHWAY SUITE 100
GRAPEVINE TX
76051
US

V. Phone/Fax

Practice location:
  • Phone: 601-326-3516
  • Fax: 601-326-6470
Mailing address:
  • Phone: 817-572-0009
  • Fax: 817-572-0221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number14337
License Number StateMS

VIII. Authorized Official

Name: MR. TODD WARREN
Title or Position: MANAGING OFFICER
Credential:
Phone: 817-572-0009