Organization
SOUTH ATLANTA DIGESTIVE DISEASES ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PETRONILLA C OKERE (OFFICE AMINISTRATOR)
(404) 761-7949
Entity
Organization
Contact information
Practice address
1151 CLEVELAND AVE, SUITE D, EAST POINT, GA 30344-3600
(404) 761-7949
(404) 761-7386
Mailing address
1151 CLEVELAND AVE, SUITE D, EAST POINT, GA 30344-3600
(404) 761-7949
(404) 761-7386
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
048686
GA
207RG0100X
Gastroenterology Physician
Primary
048686
GA
207RI0008X
Hepatology Physician
048686
GA
207RT0003X
Transplant Hepatology Physician
048686
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000893483C
—
GA
01
—
003089
BCBS
GA
Enumeration date
03/10/2008
Last updated
04/02/2024
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