Basic Information
| Provider Information | |||||||||
| NPI: | 1902811748 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TMC GASTROENTEROLOGY ASSOCIATES INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 119 AMBULANCE DR | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | CARROLLTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301173857 | ||||||||
| CountryCode: | US | ||||||||
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| FaxNumber: | 7708369261 | ||||||||
| Practice Location | |||||||||
| Address1: | 690 DALLAS HWY | ||||||||
| Address2: | SUITE 304 | ||||||||
| City: | VILLA RICA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301801209 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704563786 | ||||||||
| FaxNumber: | 7704563806 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 05/14/2008 | ||||||||
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| AuthorizedOfficialLastName: | PEARE | ||||||||
| AuthorizedOfficialFirstName: | DEBBI | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF FINANCIAL OPERATION | ||||||||
| AuthorizedOfficialTelephone: | 7708388554 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | DE8830 | 01 | GA | MEDICARE ID | OTHER |