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COLON AND RECTAL CLINIC LLC NPI 1003243072


NPI Information

NPI: 1003243072
Provider Name: COLON AND RECTAL CLINIC, LLC
Classification: Colon & Rectal Surgery - 208C00000X
Entity Type: Organization

CLIA Number: 11D2077987

Address:
3905 JOHNS CREEK CT 200
SUWANEE, GA
ZIP 30024
Phone: (770) 495-0799
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COLON AND RECTAL CLINIC, LLC is a colon rectal surgery in Suwanee, GA. The provider is a colon and rectal surgeon is trained to diagnose and treat various diseases of the intestinal tract, colon, rectum, anal canal and perianal area by medical and surgical means. This specialist also deals with other organs and tissues (such as the liver, urinary and female reproductive system) involved with primary intestinal disease. COLON AND RECTAL CLINIC, LLC NPI is 1003243072. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3905 JOHNS CREEK CT 200
SUWANEE, GA
ZIP 30024-224
Phone: (770) 495-0799
Fax: (770) 495-0783

The provider's authorized official is Kota R Venkatesh .
The authorized official title is Owner and has the following contact phone number (678) 296-5495.

The CLIA number assigned to this NPI record is 11D2077987 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/4/2013 and was last updated on 6/26/2023.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208C00000XColon & Rectal Surgery062621GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1226365641AMEDICAIDGEORGIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.