Provider Demographics
NPI:1902811748
Name:TMC GASTROENTEROLOGY ASSOCIATES INC
Entity Type:Organization
Organization Name:TMC GASTROENTEROLOGY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF FINANCIAL OPERATION
Authorized Official - Prefix:
Authorized Official - First Name:DEBBI
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-838-8554
Mailing Address - Street 1:119 AMBULANCE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3857
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:770-836-9261
Practice Address - Street 1:690 DALLAS HWY
Practice Address - Street 2:SUITE 304
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-1209
Practice Address - Country:US
Practice Address - Phone:770-456-3786
Practice Address - Fax:770-456-3806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADE8830OtherMEDICARE ID
GADE8830OtherMEDICARE ID