Organization Active NPI

Southern Gastroenterology Specialists, P.C

  • Specialist
  • Locust Grove, GA
National Provider Identifier
1952405052
Registry record updated Nov 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
SOUTHERN GASTROENTEROLOGY SPECIALISTS, P.C
Practice address
4865 Bill Gardner Pkwy
Locust Grove, GA 30248-3644
Phone
(770) 692-0100
NPI assigned
Sep 11, 2006
Last updated
Nov 12, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2010

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

Authorized official

Name
Aruna R Prakash, B.SC
Title
Secretory
Phone
(770) 692-0100

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X Primary

Addresses

Primary practice location

4865 Bill Gardner Pkwy
Locust Grove, GA 30248-3644

Mailing address

4865 Bill Gardner Pkwy
Locust Grove, GA 30248-3644
Phone (770) 692-0100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050413001069 GA Part B Supplier - Clinic/Group Practice 3577500214 Receives reassigned benefits from 7 practitioners
Practice locations: Locust Grove, GA; Stockbridge, GA

National Provider Directory

National Provider Directory

Locations

747 S 8th St
Ste B1
Griffin, GA 30224
Phone (770) 692-0100

6555 Professional Pl
Ste C
Riverdale, GA 30274
Phone (770) 692-0100

Interoperability endpoints

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

Practitioners & affiliated clinicians

Practitioners 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1157932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289520000000",
    "number": "1952405052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4865 BILL GARDNER PKWY",
            "city": "LOCUST GROVE",
            "state": "GA",
            "postal_code": "302483644",
            "telephone_number": "770-692-0100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4865 BILL GARDNER PKWY",
            "city": "LOCUST GROVE",
            "state": "GA",
            "postal_code": "302483644",
            "telephone_number": "770-692-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN GASTROENTEROLOGY SPECIALISTS, P.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-11",
        "last_updated": "2010-11-12",
        "status": "A",
        "authorized_official_last_name": "PRAKASH",
        "authorized_official_first_name": "ARUNA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "SECRETORY",
        "authorized_official_telephone_number": "770-692-0100",
        "authorized_official_credential": "B.SC"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Locust Grove, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2010; 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.