Provider Demographics
NPI:1124277058
Name:DIGESTIVE HEALTHCARE OF GEORGIA ENDOSCOPY CENTER MOUNTAINSIDE
Entity type:Organization
Organization Name:DIGESTIVE HEALTHCARE OF GEORGIA ENDOSCOPY CENTER MOUNTAINSIDE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NCIS
Authorized Official - Prefix:
Authorized Official - First Name:SHELLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-603-3543
Mailing Address - Street 1:3280 HOWELL MILL RD NW STE T100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-4122
Mailing Address - Country:US
Mailing Address - Phone:404-603-3543
Mailing Address - Fax:404-350-9316
Practice Address - Street 1:3280 HOWELL MILL RD NW STE T150
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-4123
Practice Address - Country:US
Practice Address - Phone:404-603-3543
Practice Address - Fax:404-350-8795
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DIGESTIVE HEALTHCARE OF GEORGIA ENDOSCOPY CENTER LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-16
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA400647725AMedicaid
GA111329ASCAMedicare PIN