Provider Demographics
NPI:1679153407
Name:GA GASTRO LLC
Entity type:Organization
Organization Name:GA GASTRO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ARUNA
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:PRAKASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-641-3345
Mailing Address - Street 1:1100 HOSPITAL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6381
Mailing Address - Country:US
Mailing Address - Phone:770-692-0100
Mailing Address - Fax:
Practice Address - Street 1:4865 BILL GARDNER PKWY
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:GA
Practice Address - Zip Code:30248-3644
Practice Address - Country:US
Practice Address - Phone:404-641-3345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-14
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty