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General NPI Number Information
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NPI Number | 1598916553
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Entity Type | Organization
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Legal Business Name | CENTER FOR COLON AND DIGESTIVE CARE
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Dates
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Enumeration Date | 10/08/2008
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Last Update Date | 10/08/2008
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Provider Practice Location Address
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Address Line | 14 SAMMY MCGHEE BLVD SUITE 201
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City | JASPER
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State | GA
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Zip | 30143-7721
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Country | US
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Telephone | 706-692-6566
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Fax | 706-692-3896
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Provider Business Mailing Address
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Address Line | 15 REINHARDT COLLEGE PKWY SUITE 102
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City | CANTON
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State | GA
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Zip | 30114-5257
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Country | US
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Telephone | 770-704-9499
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Fax | 770-704-9754
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CHRISTINA SWAFFORD
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Credential |
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Telephone | 770-704-9499
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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 | 046761
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License Number State | GA
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