| Organization Name: | COFFEE COUNTY CENTER FOR DIGESTIVE DISEASES LLC |
| NPI Number: | 1043411648 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SUDHAKAR JONNALAGADDA (OFFICER) |
| Mailing Address: | 300 Shirley Avenue Douglas |
| State: | GA US |
| Postal Code: | 31533 |
| Phone Number: | 9123847276 |
| Fax Number: | 9123844353 |
| NPI Enumeration Date: | 05/30/2007 |
| NPI Last Update Date: | 07/25/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | 034-295 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |