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General NPI Number Information
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NPI Number | 1821207366
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Entity Type | Organization
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Legal Business Name | GASTROENTEROLOGY AND LIVER DISEASE CENTER, LLC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 07/18/2008
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Provider Practice Location Address
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Address Line | 2337 MCCALLIE AVE SUITE 103
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City | CHATTANOOGA
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State | TN
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Zip | 37404-3257
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Country | US
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Telephone | 423-622-3494
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Fax | 423-622-3495
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Provider Business Mailing Address
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Address Line | 2337 MCCALLIE AVE PLAZA ONE, SUITE 103
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City | CHATTANOOGA
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State | TN
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Zip | 37404-3257
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Country | US
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Telephone | 423-622-3494
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Fax | 423-622-3495
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Authorized Official
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Title or Position | MEMBER/DIRECTOR
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Name | DR. REMI R JAIYEOLA
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Credential | MD
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Telephone | 423-622-3494
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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 | MD000040546
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License Number State | TN
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