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General NPI Number Information
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NPI Number | 1679153407
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Entity Type | Organization
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Legal Business Name | GA GASTRO LLC
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Dates
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Enumeration Date | 04/14/2021
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Last Update Date | 04/14/2021
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Provider Practice Location Address
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Address Line | 4865 BILL GARDNER PKWY
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City | LOCUST GROVE
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State | GA
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Zip | 30248-3644
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Country | US
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Telephone | 404-641-3345
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 HOSPITAL DR STE 200
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-6381
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Country | US
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Telephone | 770-692-0100
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ARUNA REDDY PRAKASH
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Credential |
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Telephone | 404-641-3345
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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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