Coffee County Center for Digestive Diseases LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

034-295 Issued in GA

Legal business name

COFFEE COUNTY CENTER FOR DIGESTIVE DISEASES LLC

Practice address

300 Shirley Avenue
Douglas, GA 31533

Phone

(912) 384-7276

Fax

(912) 384-4353

NPI assigned

May 30, 2007

Last updated

May 19, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sudhakar Jonnalagadda, MDNPI 1043203011

Title

Officer

Phone

(912) 384-7276

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Listed as

Coffee County Center for Digestive Diseases LLCCCN 11C0001246

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Sudhakar Jonnalagadda, MD

  • Gastroenterology Physician
  • Douglas, GA
  • NPI 1043203011
  NPD Authorized official

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1652918400000",
    "number": "1043411648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 SHIRLEY AVENUE",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "31533",
            "telephone_number": "912-384-7276",
            "fax_number": "912-384-4353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 SHIRLEY AVENUE",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "31533",
            "telephone_number": "912-384-7276",
            "fax_number": "912-384-4353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COFFEE COUNTY CENTER FOR DIGESTIVE DISEASES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-30",
        "last_updated": "2022-05-19",
        "certification_date": "2022-05-19",
        "status": "A",
        "authorized_official_last_name": "JONNALAGADDA",
        "authorized_official_first_name": "SUDHAKAR",
        "authorized_official_title_or_position": "OFFICER",
        "authorized_official_telephone_number": "912-384-7276",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "034-295",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "474131643A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE PERMIT",
            "identifier": "034-295",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Coffee Chiropractic LLC
• Coffee County Board of Education
• Coffee County Board of Education
• Coffee County Board of Health (Coffee Wellness Center)
• Coffee County Board of Health
• Coffee County Hospitalist Physicians, LLC
• Coffee County Nursing Home LLC (Vista Park Health and Rehabilitation)
• Coffee County Nursing Home, LLC (Shady Acres)
• Coffee County Nursing Home, LLC (Shady Acres)
• Coffee County Pediatrics PC

• Ambulatory Surgical Clinic/Center in Douglas, GA
• Providers in Douglas, GA by specialty
• Ambulatory Surgical Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.