Organization Name: | NORTHEAST GEORGIA GASTROENTEROLOGY ASSOCIATES, PC |
NPI Number: | 1427100106 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | STEPHEN WILLIAM WILDE (PRESIDENT CEO MD) |
Mailing Address: | 700 Sunset Dr Suite 501 Athens |
State: | GA US |
Postal Code: | 306062293 |
Phone Number: | 7062080065 |
Fax Number: | 7065498693 |
NPI Enumeration Date: | 01/16/2007 |
NPI Last Update Date: | 02/19/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 33231 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |