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General NPI Number Information
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NPI Number | 1609099373
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Entity Type | Organization
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Legal Business Name | ADVANCED GASTROENTEROLOGY ASSOCIATES, LLC
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4275 JOHNS CREEK PKWY SUITE A
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City | SUWANEE
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State | GA
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Zip | 30024-6038
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Country | US
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Telephone | 678-475-1606
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Fax |
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Provider Business Mailing Address
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Address Line | 4275 JOHNS CREEK PKWY SUITE A
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City | SUWANEE
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State | GA
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Zip | 30024-6038
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Country | US
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Telephone | 678-475-1606
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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. BRIAN KEITH HUDES
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Credential | MD
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Telephone | 678-475-1606
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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 | 042852
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License Number State | GA
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