Organization
COFFEE COUNTY CENTER FOR DIGESTIVE DISEASES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUDHAKAR JONNALAGADDA MD (OFFICER)
(912) 384-7276
Entity
Organization
Contact information
Practice address
300 SHIRLEY AVENUE, DOUGLAS, GA 31533
(912) 384-7276
(912) 384-4353
Mailing address
300 SHIRLEY AVENUE, DOUGLAS, GA 31533
(912) 384-7276
(912) 384-4353
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
034-295
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
034-295
STATE PERMIT
GA
05
—
474131643A
—
GA
Enumeration date
05/30/2007
Last updated
05/19/2022
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