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General NPI Number Information
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NPI Number | 1053735761
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Entity Type | Organization
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Legal Business Name | DIGESTIVE HEALTHCARE OF GA, P.C.
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Dates
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Enumeration Date | 02/17/2014
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 433 HIGHLAND PKWY STE 201
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City | EAST ELLIJAY
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State | GA
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Zip | 30540-7658
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Country | US
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Telephone | 706-253-5514
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Fax | 706-515-7203
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Provider Business Mailing Address
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Address Line | 3280 HOWELL MILL RD NW STE T100
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City | ATLANTA
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State | GA
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Zip | 30327-4122
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Country | US
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Telephone | 140-460-3354
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Fax | 404-350-8795
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Authorized Official
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Title or Position | DIRECTOR RNC
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Name | SHELLY M ROBINSON
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Credential |
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Telephone | 404-603-3543
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 207RG0100X
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License Number State | GA
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