MEDICARE: ATHENS DIGESTIVE ENDOSCOPY CENTER

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	261QE0800X	Endoscopy Clinic/Center		GA

General Provider Information

NPI Number	:	1356732804
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ATHENS DIGESTIVE ENDOSCOPY CENTER

Provider Business Mailing Address
First Line	:	1360 CADUCEUS WAY, BUILDING 300
Second Line	:	SUITE 101
City	:	WATKINSVILLE
State	:	GA
Zip	:	30677-7300
Country	:	US
Telephone Number	:	706-850-4985
Fax Number	:	706-850-4989

Provider Business Practice Location Address
First Line	:	1360 CADUCEUS WAY
Second Line	:	BUILDING 300
City	:	WATKINSVILLE
State	:	GA
Zip	:	30677-7300
Country	:	US
Telephone Number	:	706-850-4985
Fax Number	:	706-850-4989

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. ASIF MIAN QADRI
Credential	:	M.D.
Telephone Number	:	706-850-4985

Provider Enumeration Date	:	02/05/2015
Last Update Date	:	04/07/2020

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