MEDICARE: DIGESTIVE HEALTHCARE OF GEORGIA ENDOSCOPY CENTER 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	261QA1903X	Ambulatory Surgical Clinic/Center	060155	GA

General Provider Information

NPI Number	:	1861496564
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIGESTIVE HEALTHCARE OF GEORGIA ENDOSCOPY CENTER LLC

Provider Business Mailing Address
First Line	:	3280 HOWELL MILL RD NW STE T150
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-4111
Country	:	US
Telephone Number	:	404-603-3543
Fax Number	:	404-350-8795

Provider Business Practice Location Address
First Line	:	3280 HOWELL MILL RD NW STE T150
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30327-4111
Country	:	US
Telephone Number	:	404-603-3543
Fax Number	:	404-350-8795

Authorized Official
Title or Position	:	DIRECTOR OF NCIS
Name	:	SHELLY M ROBINSON
Credential	:
Telephone Number	:	404-603-3543

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	05/06/2025

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