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General NPI Number Information
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NPI Number | 1265427041
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Entity Type | Organization
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Legal Business Name | GASTROENTEROLOGY CENTER OF WEST GEORGIA PC
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Dates
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Enumeration Date | 09/16/2005
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Last Update Date | 01/20/2011
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Provider Practice Location Address
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Address Line | 1551 DOCTORS DR
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City | LAGRANGE
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State | GA
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Zip | 30240-4139
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Country | US
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Telephone | 703-684-5771
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Fax | 706-882-1620
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Provider Business Mailing Address
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Address Line | 1551 DOCTORS DR
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City | LAGRANGE
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State | GA
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Zip | 30240-4139
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Country | US
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Telephone | 706-845-7711
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Fax | 706-882-1620
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN ROBERT COGGINS VII
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Credential | M.D.
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Telephone | 706-845-7711
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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 |
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License Number State |
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