Provider Demographics
NPI:1124172952
Name:ATLANTA WEST GASTROENTEROLOGY ASSOCIATES PC
Entity type:Organization
Organization Name:ATLANTA WEST GASTROENTEROLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NAVINCHANDRA
Authorized Official - Middle Name:M
Authorized Official - Last Name:RUPARELIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-949-6548
Mailing Address - Street 1:6084 PROFESSIONAL PARKWAY
Mailing Address - Street 2:SUITE #C
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134
Mailing Address - Country:US
Mailing Address - Phone:770-949-6548
Mailing Address - Fax:770-949-9561
Practice Address - Street 1:6084 PROFESSIONAL PARKWAY
Practice Address - Street 2:SUITE #C
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134
Practice Address - Country:US
Practice Address - Phone:770-949-6548
Practice Address - Fax:770-949-9561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA26928207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00301122AMedicaid
D42179Medicare UPIN
GA00301122AMedicaid