Basic Information
| Provider Information | |||||||||
| NPI: | 1053559542 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GI CARE FOR KIDS ENDOSCOPY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 993 JOHNSON FERRY RD NE # D | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042570799 | ||||||||
| FaxNumber: | 4045032280 | ||||||||
| Practice Location | |||||||||
| Address1: | 993 JOHNSON FERRY RD NE # D | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421620 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042570799 | ||||||||
| FaxNumber: | 4045032280 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2009 | ||||||||
| LastUpdateDate: | 01/30/2009 | ||||||||
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| AuthorizedOfficialLastName: | GEBHART | ||||||||
| AuthorizedOfficialFirstName: | LAURI | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4045032271 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0206X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Gastroenterology | 261QE0800X | Y | Ambulatory Health Care Facilities | Clinic/Center | Endoscopy |
No ID Information.