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NPI Code Detail

MEDICARE: SOUTHEASTERN GASTROENTEROLOGY ASSOCIATES, PC

MEDICARE: SOUTHEASTERN GASTROENTEROLOGY ASSOCIATES, PC
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
12080P0206XPediatric Gastroenterology Physician
2207RG0100XGastroenterology Physician

General Provider Information

NPI Number : 1467196139
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHEASTERN GASTROENTEROLOGY ASSOCIATES, PC
Provider Business Mailing Address
First Line : PO BOX 8629
Second Line :
City : COLUMBUS
State : GA
Zip : 31908-8629
Country : US
Telephone Number : 706-655-8800
Fax Number : 706-940-4764
Provider Business Practice Location Address
First Line : 2200 HAMILTON RD STE B
Second Line :
City : COLUMBUS
State : GA
Zip : 31904-8856
Country : US
Telephone Number : 706-655-8800
Fax Number : 706-940-4764
Authorized Official
Title or Position : CEO
Name : SHANE B DARRAH
Credential : MD
Telephone Number : 706-243-4500
Provider Enumeration Date : 04/27/2022
Last Update Date : 08/24/2022

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