Basic Information
| Provider Information | |||||||||
| NPI: | 1891737532 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GASTROENTEROLOGY ATLANTA, LLC | ||||||||
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| Address1: | 3025 BRECKINRIDGE BLVD | ||||||||
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| City: | DULUTH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300964979 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6782260082 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5669 PEACHTREE DUNWOODY RD NE | ||||||||
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| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421786 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042570000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/10/2006 | ||||||||
| LastUpdateDate: | 01/16/2019 | ||||||||
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| AuthorizedOfficialLastName: | LYDAY | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7704006041 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 008698 | GA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.