Provider Demographics
NPI:1730221409
Name:DIGESTIVE ASSOCIATES, INC.
Entity type:Organization
Organization Name:DIGESTIVE ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:HUITT
Authorized Official - Middle Name:E
Authorized Official - Last Name:MATTOX
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:912-267-0058
Mailing Address - Street 1:3217 4TH ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-3759
Mailing Address - Country:US
Mailing Address - Phone:912-267-0058
Mailing Address - Fax:912-267-0061
Practice Address - Street 1:3217 4TH ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-3759
Practice Address - Country:US
Practice Address - Phone:912-267-0058
Practice Address - Fax:912-267-0061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
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
GA300023313AMedicaid
GAGRP1521Medicare PIN