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General NPI Number Information
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NPI Number | 1891912713
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Entity Type | Organization
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Legal Business Name | SOUTHEAST GEORGIA GASTROENTEROLOGY PC
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2003 PIONEER ST # A
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City | WAYCROSS
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State | GA
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Zip | 31501-6249
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Country | US
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Telephone | 912-284-1210
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Fax |
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Provider Business Mailing Address
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Address Line | 2003 PIONEER ST # A
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City | WAYCROSS
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State | GA
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Zip | 31501-6249
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Country | US
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Telephone | 912-284-1210
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AHMAD IRFAN
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Credential | MD
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Telephone | 912-284-1210
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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 | 041584
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License Number State | GA
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