| Gastro South, Llc | |
|
240 Sheraton Blvd Macon GA 31210-1358 | |
| (706) 495-5718 | |
| Not Available |
| Full Name | Gastro South, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 240 Sheraton Blvd, Macon, Georgia |
| Authorized Official Name and Position | Joel Judah (MANAGING MEMBER) |
| Authorized Official Contact | 7064955718 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gastro South, Llc 9172 Estes Rd Macon GA 31220-5603 Ph: (706) 495-5718 | Gastro South, Llc 240 Sheraton Blvd Macon GA 31210-1358 Ph: (706) 495-5718 |
| NPI Number | 1790440204 |
|---|---|
| Provider Enumeration Date | 11/01/2021 |
| Last Update Date | 11/01/2021 |
| Medicare PECOS PAC ID | 9638535560 |
|---|---|
| Medicare Enrollment ID | O20230519001154 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790440204 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| Provider Name | William K Fackler |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1245236082 PECOS PAC ID: 0749211290 Enrollment ID: I20050825000104 |
| Provider Name | Joel R Judah |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1215097852 PECOS PAC ID: 1759432719 Enrollment ID: I20100929000660 |
| Provider Name | Jay M Anderson |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1528245784 PECOS PAC ID: 2769626928 Enrollment ID: I20140709000349 |
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