Provider Demographics
NPI:1053735761
Name:DIGESTIVE HEALTHCARE OF GA, P.C.
Entity type:Organization
Organization Name:DIGESTIVE HEALTHCARE OF GA, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR RNC
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-603-3543
Mailing Address - Street 1:3280 HOWELL MILL RD NW STE T100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-4122
Mailing Address - Country:US
Mailing Address - Phone:140-460-3354
Mailing Address - Fax:404-350-8795
Practice Address - Street 1:433 HIGHLAND PKWY STE 201
Practice Address - Street 2:
Practice Address - City:EAST ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-7658
Practice Address - Country:US
Practice Address - Phone:706-253-5514
Practice Address - Fax:706-515-7203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-17
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207RG0100X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty