Organization Active NPI

Advanced Digestive Care Center,P.C.

  • Gastroenterology Physician
  • Stockbridge, GA
National Provider Identifier
1831274034
Registry record updated Oct 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
ADVANCED DIGESTIVE CARE CENTER,P.C.
Practice address
235 Medical Blvd
Suite a
Stockbridge, GA 30281-7218
Phone
(678) 783-0300
Fax
(678) 565-9473
NPI assigned
Oct 26, 2006
Last updated
Oct 19, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2012

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

Authorized official

Name
Dr. Celestine Maiki, M.D.
Title
President
Phone
(678) 783-0300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

235 Medical Blvd
Suite a
Stockbridge, GA 30281-7218

Mailing address

235 Medical Blvd
Suite a
Stockbridge, GA 30281
Phone (678) 783-0300

Other identifiers 1

IdentifierTypeStateIssuer
199807383AMedicaidGA

Other names 1

  • Advanced Digestive Diseases, P.C. Former legal business name

National Provider Directory

National Provider Directory

Locations

235 Medical Blvd
#A
Stockbridge, GA 30281
Phone (678) 565-9457

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350604800000",
    "number": "1831274034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "235 MEDICAL BLVD",
            "address_2": "SUITE A",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "30281",
            "telephone_number": "678-783-0300",
            "fax_number": "678-565-9473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "235 MEDICAL BLVD",
            "address_2": "SUITE A",
            "city": "STOCKBRIDGE",
            "state": "GA",
            "postal_code": "302817218",
            "telephone_number": "678-783-0300",
            "fax_number": "678-565-9473"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED DIGESTIVE CARE CENTER,P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2012-10-19",
        "status": "A",
        "authorized_official_last_name": "MAIKI",
        "authorized_official_first_name": "CELESTINE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "678-783-0300",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "199807383A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Digestive Diseases, P.C.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Stockbridge, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.