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General NPI Number Information
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NPI Number | 1477712115
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Entity Type | Organization
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Legal Business Name | GEORGIA GASTROENTEROLOGY LLC
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Dates
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Enumeration Date | 06/07/2008
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Last Update Date | 06/07/2008
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Provider Practice Location Address
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Address Line | 1701 MAGNOLIA WAY SUITE 201
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City | AUGUSTA
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State | GA
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Zip | 30909-9483
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Country | US
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Telephone | 706-922-7777
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Fax |
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Provider Business Mailing Address
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Address Line | 1701 MAGNOLIA WAY SUITE 201
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City | AUGUSTA
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State | GA
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Zip | 30909-9483
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Country | US
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Telephone | 706-922-7777
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. AYAZ J. CHAUDHARY
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Credential | MD
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Telephone | 706-922-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 044896
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 044896
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License Number State | GA
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