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General NPI Number Information
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NPI Number | 1154491520
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Entity Type | Organization
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Legal Business Name | DIGESTIVE ASSOCIATES, P.C.
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Dates
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Enumeration Date | 11/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1067 VENDALL RD
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City | DYERSBURG
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State | TN
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Zip | 38024-1622
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Country | US
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Telephone | 731-285-5133
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Fax | 731-285-9921
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Provider Business Mailing Address
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Address Line | 710 HWY 51 BYPASS WEST PMB 770
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City | DYERSBURG
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State | TN
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Zip | 38024
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Country | US
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Telephone | 731-285-5133
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Fax | 731-285-9921
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. MARY E ELLIOTT
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Credential |
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Telephone | 731-285-5133
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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