NPI 1386670404

Advanced Gastroenterology Group

Organisation Exclusive Provider Organization Woodstock, GA

Practice location

Address: 4595 Towne Lake Pkwy Bldg 300, Suite 200, Woodstock, GA 30189-5514
Phone: (770) 509-0089
Fax: (678) 888-0642

Authorised official

Name: Sharon E Jackson
Title: Office Manager
Phone: (770) 509-0089

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence 030681 (GA)

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Registry record

NPI: 1386670404
Entity type: Organization
NPI issued: 23 Jun 2006
Record last updated: 30 Apr 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.