Provider Demographics
NPI:1861596967
Name:G.I.ENDOSCOPY CENTER
Entity type:Organization
Organization Name:G.I.ENDOSCOPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:R
Authorized Official - Last Name:PRAKASH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-996-5959
Mailing Address - Street 1:6555 PROFESSIONAL PL
Mailing Address - Street 2:SUITE B
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-4903
Mailing Address - Country:US
Mailing Address - Phone:770-996-5959
Mailing Address - Fax:
Practice Address - Street 1:6555 PROFESSIONAL PL
Practice Address - Street 2:SUITE B
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-4903
Practice Address - Country:US
Practice Address - Phone:770-996-5959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical