# ADVANCED GASTROENTEROLOGY GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** ADVANCED GASTROENTEROLOGY GROUP
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386670404
- **Authorized official:** MRS. SHARON E JACKSON (OFFICE MANAGER)
- **Authorized official phone:** (770) 509-0089

## Contact information

- **Practice address:** 4595 TOWNE LAKE PKWY, BLDG 300, SUITE 200, WOODSTOCK, GA 30189-5514
- **Practice address phone:** (770) 509-0089
- **Practice address fax:** (678) 888-0642
- **Mailing address:** 4595 TOWNE LAKE PKWY, BLDG 300, SUITE 200, WOODSTOCK, GA 30189-5514
- **Mailing address phone:** (770) 509-0089
- **Mailing address fax:** (678) 888-0642

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | 030681 | GA | Yes |

## Other

- **Enumeration date:** 06/23/2006
- **Last updated:** 04/30/2008