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Organization
COLON AND RECTAL CLINIC, LLC
Active
Organization
COLON AND RECTAL CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KOTA R VENKATESH M.D. (OWNER)
(678) 296-5495
Entity
Organization
Contact information
Practice address
3905 JOHNS CREEK CT 200, SUWANEE, GA 30024-1224
(770) 495-0799
(770) 495-0783
Mailing address
3905 JOHNS CREEK COURT SUITE 200, SUWANEE, GA 30024
(770) 495-0799
(770) 495-0783
Taxonomy
Speciality
Code
Description
License number
State
208C00000X
Colon & Rectal Surgery Physician
Primary
062621
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
226365641A
—
GA
Enumeration date
10/04/2013
Last updated
06/26/2023
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