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General NPI Number Information
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NPI Number | 1487684031
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Entity Type | Organization
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Legal Business Name | GASTROENTEROLOGY ASSOCIATES, PA
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 08/30/2022
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Provider Practice Location Address
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Address Line | 125 HALTON ROAD SUITE 200
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City | GREENVILLE
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State | SC
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Zip | 29607-3507
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Country | US
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Telephone | 864-232-7338
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Fax | 864-239-6645
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Provider Business Mailing Address
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Address Line | PO BOX 8676
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City | GREENVILLE
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State | SC
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Zip | 29604-8676
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Country | US
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Telephone | 864-232-7338
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Fax | 864-239-6645
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. JOHN HICKEY
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Credential |
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Telephone | 864-232-7338
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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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