Provider Demographics
NPI:1871365478
Name:GASTROCARE PHYSICIANS OF GEORGIA LLC
Entity type:Organization
Organization Name:GASTROCARE PHYSICIANS OF GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:NEAL
Authorized Official - Last Name:SOCOLOFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-386-7480
Mailing Address - Street 1:5400 GLENRIDGE DR UNIT 420337
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-7513
Mailing Address - Country:US
Mailing Address - Phone:678-447-0678
Mailing Address - Fax:
Practice Address - Street 1:1680A EATONTON RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:GA
Practice Address - Zip Code:30650-4628
Practice Address - Country:US
Practice Address - Phone:404-282-5600
Practice Address - Fax:404-282-5599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-26
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty