| South Ga Gastroenterology & Nutrition Support, Inc. | |
|
2509 S Main St Moultrie GA 31768-6530 | |
| (229) 985-1230 | |
| (229) 985-1233 |
| Full Name | South Ga Gastroenterology & Nutrition Support, Inc. |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 2509 S Main St, Moultrie, Georgia |
| Authorized Official Name and Position | Linda Kay Cole (PRACTICE MANAGER) |
| Authorized Official Contact | 2299851230 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| South Ga Gastroenterology & Nutrition Support, Inc. 2509 S Main St Moultrie GA 31768-6530 Ph: (229) 985-1230 | South Ga Gastroenterology & Nutrition Support, Inc. 2509 S Main St Moultrie GA 31768-6530 Ph: (229) 985-1230 |
| NPI Number | 1609938026 |
|---|---|
| Provider Enumeration Date | 12/14/2006 |
| Last Update Date | 01/04/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609938026 | NPI | - | NPPES |
| 000810939B | Medicaid | GA | |
| 100012828 | Other | GA | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | 46662 (Georgia) | Primary |
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