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General NPI Number Information
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NPI Number | 1558551275
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Entity Type | Organization
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Legal Business Name | GEORGIA GASTROINTESTINAL AND LIVER DISEASE ASSOCIATES PC
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 07/13/2018
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Provider Practice Location Address
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Address Line | 962 JOE FRANK HARRIS PKWY SE STE 106
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City | CARTERSVILLE
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State | GA
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Zip | 30120
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Country | US
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Telephone | 770-382-1926
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Fax |
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Provider Business Mailing Address
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Address Line | 962 JOE FRANK HARRIS PKWY SE
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City | CARTERSVILLE
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State | GA
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Zip | 30120-2154
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Country | US
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Telephone | 770-382-1926
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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. YAMAN TAYARA
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Credential |
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Telephone | 770-382-1926
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 045641
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License Number State | GA
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