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General NPI Number Information
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NPI Number | 1356732804
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Entity Type | Organization
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Legal Business Name | ATHENS DIGESTIVE ENDOSCOPY CENTER
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Dates
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Enumeration Date | 02/05/2015
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Last Update Date | 04/07/2020
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Provider Practice Location Address
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Address Line | 1360 CADUCEUS WAY BUILDING 300
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City | WATKINSVILLE
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State | GA
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Zip | 30677-7300
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Country | US
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Telephone | 706-850-4985
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Fax | 706-850-4989
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Provider Business Mailing Address
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Address Line | 1360 CADUCEUS WAY, BUILDING 300 SUITE 101
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City | WATKINSVILLE
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State | GA
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Zip | 30677-7300
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Country | US
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Telephone | 706-850-4985
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Fax | 706-850-4989
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ASIF MIAN QADRI
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Credential | M.D.
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Telephone | 706-850-4985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number |
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License Number State | GA
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