Provider Demographics
NPI:1194760553
Name:DIGESTIVE & LIVER DISEASE SPECIALISTS
Entity type:Organization
Organization Name:DIGESTIVE & LIVER DISEASE SPECIALISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARION
Authorized Official - Middle Name:NESBIT
Authorized Official - Last Name:DASHER
Authorized Official - Suffix:JR
Authorized Official - Credentials:M D
Authorized Official - Phone:706-722-2400
Mailing Address - Street 1:820 SAINT SEBASTIAN WAY
Mailing Address - Street 2:SUITE 5B
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-2643
Mailing Address - Country:US
Mailing Address - Phone:706-722-2400
Mailing Address - Fax:706-724-9211
Practice Address - Street 1:820 SAINT SEBASTIAN WAY
Practice Address - Street 2:SUITE 5B
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-2643
Practice Address - Country:US
Practice Address - Phone:706-722-2400
Practice Address - Fax:706-724-9211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP500Medicare PIN