MEDICARE: AGA PROFESSIONAL SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician		GA

General Provider Information

NPI Number	:	1063799120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AGA PROFESSIONAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	1000 JOHNSON FY RD NE
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30342-1606
Country	:	US
Telephone Number	:	404-851-8000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 JOHNSON FERRY RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30342-1606
Country	:	US
Telephone Number	:	855-709-4535
Fax Number	:

Authorized Official
Title or Position	:	CHIEF COMPLIANCE OFFICER
Name	:	AMY E FOUTS
Credential	:
Telephone Number	:	404-851-6968

Provider Enumeration Date	:	11/03/2011
Last Update Date	:	06/09/2026

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