COFFEE COUNTY CENTER FOR DIGESTIVE DISEASES LLC – NPI #1043411648
Clinic/Center

COFFEE COUNTY CENTER FOR DIGESTIVE DISEASES LLC is an AHC clinic located in DOUGLAS, GA. NPPES has assigned the NPI number 1043411648 to COFFEE COUNTY CENTER FOR DIGESTIVE DISEASES LLC on May 30, 2007. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 261QA1903X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in Ambulatory Surgical

The NPI profile was previously updated about 4 years ago on May 19, 2022. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for COFFEE COUNTY CENTER FOR DIGESTIVE DISEASES LLC below.

NPI Profile for
COFFEE COUNTY CENTER FOR DIGESTIVE DISEASES LLC

NPI Number
1043411648
Enumeration Date

(more than 19 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
COFFEE COUNTY CENTER FOR DIGESTIVE DISEASES LLC
Primary location
300 SHIRLEY AVENUE
DOUGLAS, GA 31533
Phone: (912) 384-7276 Fax: (912) 384-4353
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
SUDHAKAR JONNALAGADDA
OFFICER
Phone: (912) 384-7276
Updated
Certification Date
May 19, 2022

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Identifiers

Identifiers for COFFEE COUNTY CENTER FOR DIGESTIVE DISEASES LLC

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
OTHERSTATE PERMITGA034-295
MEDICAIDGA474131643A
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QA1903X
- Clinic/Center / Ambulatory Surgical (Primary)		 GA 034-295

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.