# COLON AND RECTAL CLINIC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1003243072
- **Authorized official:** KOTA R VENKATESH M.D. (OWNER)
- **Authorized official phone:** (678) 296-5495

## Contact information

- **Practice address:** 3905 JOHNS CREEK CT 200, SUWANEE, GA 30024-1224
- **Practice address phone:** (770) 495-0799
- **Practice address fax:** (770) 495-0783
- **Mailing address:** 3905 JOHNS CREEK COURT SUITE 200, SUWANEE, GA 30024
- **Mailing address phone:** (770) 495-0799
- **Mailing address fax:** (770) 495-0783

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208C00000X | Colon & Rectal Surgery Physician | 062621 | GA | Yes |

## Other

- **Enumeration date:** 10/04/2013
- **Last updated:** 06/26/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 226365641A | — | GA |