| Southeastern Gastroenterology Associates, Pc | |
|
2200 Hamilton Rd Ste B Columbus GA 31904-8856 | |
| (706) 655-8800 | |
| (706) 940-4764 |
| Full Name | Southeastern Gastroenterology Associates, Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2200 Hamilton Rd Ste B, Columbus, Georgia |
| Authorized Official Name and Position | Shane B Darrah (CEO) |
| Authorized Official Contact | 7062434500 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeastern Gastroenterology Associates, Pc Po Box 8629 Columbus GA 31908-8629 Ph: (706) 655-8800 | Southeastern Gastroenterology Associates, Pc 2200 Hamilton Rd Ste B Columbus GA 31904-8856 Ph: (706) 655-8800 |
| NPI Number | 1467196139 |
|---|---|
| Provider Enumeration Date | 04/27/2022 |
| Last Update Date | 08/24/2022 |
| Medicare PECOS PAC ID | 5597149682 |
|---|---|
| Medicare Enrollment ID | O20220909000291 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467196139 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
| 2080P0206X | Pediatrics - Pediatric Gastroenterology | (* (Not Available)) | Secondary |
| Provider Name | Mark R Fortson |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1457452591 PECOS PAC ID: 4789782756 Enrollment ID: I20070614000539 |
| Provider Name | Carter D Wallace |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1497037899 PECOS PAC ID: 8022339647 Enrollment ID: I20220909000628 |
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