Colon and Rectal Clinic, LLC

Primary specialty

Colon & Rectal Surgery PhysicianTaxonomy code 208C00000X

License

062621 Issued in GA

Legal business name

COLON AND RECTAL CLINIC, LLC

Practice address

3905 Johns Creek CT 200
Suwanee, GA 30024-1224

Phone

(770) 495-0799

Fax

(770) 495-0783

NPI assigned

Oct 4, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kota R Venkatesh, M.D.NPI 1609067081

Title

Owner

Phone

(678) 296-5495

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/JIFDCA

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kota Venkatesh, MD

  • Colon & Rectal Surgery Physician
  • Suwanee, GA
  • NPI 1609067081

  Colon & Rectal Surgery, GA

  Medicare reassignment NPD Authorized official
• Shirley S Rosales Mejia, PAC

  • Physician Assistant
  • Suwanee, GA
  • NPI 1669200192

  GA

  Medicare reassignment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1380844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687737600000",
    "number": "1003243072",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3905 JOHNS CREEK COURT SUITE 200",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "30024",
            "telephone_number": "770-495-0799",
            "fax_number": "770-495-0783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3905 JOHNS CREEK CT 200",
            "city": "SUWANEE",
            "state": "GA",
            "postal_code": "300241224",
            "telephone_number": "770-495-0799",
            "fax_number": "770-495-0783"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "761 Walther Road Suite 300",
            "address_purpose": "LOCATION",
            "city": "Lawrenceville",
            "state": "GA",
            "postal_code": "300461224",
            "country_code": "US",
            "telephone_number": "770-495-0799",
            "fax_number": "770-495-0783",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "COLON AND RECTAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-04",
        "last_updated": "2023-06-26",
        "certification_date": "2023-06-26",
        "status": "A",
        "authorized_official_last_name": "VENKATESH",
        "authorized_official_first_name": "KOTA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-296-5495",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208C00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Colon & Rectal Surgery",
            "state": "GA",
            "license": "062621",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "226365641A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kenneth Cohen-Sasson, D.M.D.
• Rachel Nalini Cole
• Wendell W. Cole III, MD
• Janice M Collins
• Paris Collins, MD
• Complete Dental of Suwanee
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• Comprehensive Internal Medicine
• Comprehensive Neurology Specialist

• All providers in Suwanee, GA
• Colon & Rectal Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.