MEDICARE: SOUTH ATLANTA DIGESTIVE DISEASES ASSOCIATES

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	207R00000X	Internal Medicine Physician	048686	GA
2	207RI0008X	Hepatology Physician	048686	GA
3	207RT0003X	Transplant Hepatology Physician	048686	GA
4	207RG0100X	Gastroenterology Physician	048686	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	003089	OTHER	GA	BCBS

General Provider Information

NPI Number	:	1841460490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH ATLANTA DIGESTIVE DISEASES ASSOCIATES

Provider Business Mailing Address
First Line	:	1151 CLEVELAND AVE
Second Line	:	SUITE D
City	:	EAST POINT
State	:	GA
Zip	:	30344-3600
Country	:	US
Telephone Number	:	404-761-7949
Fax Number	:	404-761-7386

Provider Business Practice Location Address
First Line	:	1151 CLEVELAND AVE
Second Line	:	SUITE D
City	:	EAST POINT
State	:	GA
Zip	:	30344-3600
Country	:	US
Telephone Number	:	404-761-7949
Fax Number	:	404-761-7386

Authorized Official
Title or Position	:	OFFICE AMINISTRATOR
Name	:	MS. PETRONILLA C OKERE
Credential	:
Telephone Number	:	404-761-7949

Provider Enumeration Date	:	03/10/2008
Last Update Date	:	04/02/2024

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Directions to “SOUTH ATLANTA DIGESTIVE DISEASES ASSOCIATES ” Practice Location

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