Organization
ADVANCED GASTROENTEROLOGY GROUP
Active
Other names
ADVANCED GASTROENTEROLOGY GROUP
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SHARON E JACKSON (OFFICE MANAGER)
(770) 509-0089
Entity
Organization
Contact information
Practice address
4595 TOWNE LAKE PKWY, BLDG 300, SUITE 200, WOODSTOCK, GA 30189-5514
(770) 509-0089
(678) 888-0642
Mailing address
4595 TOWNE LAKE PKWY, BLDG 300, SUITE 200, WOODSTOCK, GA 30189-5514
(770) 509-0089
(678) 888-0642
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
030681
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1447206164
NPI #
GA
Enumeration date
06/23/2006
Last updated
04/30/2008
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