=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518990472
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GASTROENTEROLOGY ASSOCIATES VA, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/07/2006
-----------------------------------------------------
Last Update Date | 09/03/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7915 LAKE MANASSAS DR STE 302
-----------------------------------------------------
City | GAINESVILLE
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20155-3260
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-248-0653
-----------------------------------------------------
Fax | 571-248-0658
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 381468
-----------------------------------------------------
City | GERMANTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38183-1468
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax | 901-328-1355
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR, CREDENTIALING
-----------------------------------------------------
Name | AIMEE CATHLEEN JUDY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 901-737-4665
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 0101027526
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------