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General NPI Number Information
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NPI Number | 1295193399
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Entity Type | Organization
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Legal Business Name | AGA CLINICAL SERVICES, LLC
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Dates
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Enumeration Date | 02/03/2016
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Last Update Date | 03/08/2023
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Provider Practice Location Address
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Address Line | 1000 JOHNSON FY RD NE
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City | ATLANTA
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State | GA
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Zip | 30342-1606
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Country | US
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Telephone | 800-858-1014
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 JOHNSON FY RD NE
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City | ATLANTA
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State | GA
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Zip | 30342-1606
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Country | US
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Telephone | 404-851-6378
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Fax |
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Authorized Official
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Title or Position | VP ADMIN. SERVICES/CCO
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Name | JORGE J HERNANDEZ
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Credential |
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Telephone | 404-851-6378
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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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