SOUTHERN ENDOSCOPY SUITE, LLC (NPI# 1215986609) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215986609 |
| Entity Type | Organization |
| Organization Name | SOUTHERN ENDOSCOPY SUITE, LLC |
| Practice Address |
763 Old Norcross Rd Lawrenceville GA 30045-4317 |
| Practice Telephone | 6789852000 |
| Practice Fax Number | 6789851999 |
| Mailing Telephone | 6789852000 |
| Mailing Fax Number | 6789851999 |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2017-11-28 |
| Authorized Official Name | MARK B. KUKLER (OWNER) |
| Authorized Official Telephone | 6789852000 |
| Authorized Official Credential | D.O., |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
Ambulatory Health Care Facilities | ||
| Y | 261QE0800X |
Clinic/Center Specialization: Endoscopy |
067-200 | GA | Ambulatory Health Care Facilities |
| Street Address |
763 OLD NORCROSS RD |
| City | LAWRENCEVILLE |
| State | GA |
| Zip Code | 30045-4317 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952350332 | Tanya M. Rutledge | Internal Medicine | 763 Old Norcross Rd, Lawrenceville, GA 30046-4317 | 2006-05-10 |
| 1568897668 | Stephen Beasley | Internal Medicine | 763 Old Norcross Rd, Lawrenceville, GA 30046-4317 | 2013-09-08 |
| 1053750646 | Sg Anesthesia LLC | Nurse Anesthetist, Certified Registered | 763 Old Norcross Rd, Lawrenceville, GA 30046-4317 | 2013-06-18 |
| 1013264654 | Ahp of Gwinnett, LLC | Nurse Anesthetist, Certified Registered | 763 Old Norcross Rd, Lawrenceville, GA 30046-4317 | 2012-08-14 |
| 1952588394 | Amil P Patel | Internal Medicine | 763 Old Norcross Rd, Lawrenceville, GA 30046-4317 | 2008-01-29 |
| 1295785814 | Marcelle M. Owens | Internal Medicine | 763 Old Norcross Rd, Lawrenceville, GA 30046-4317 | 2006-05-12 |
| 1093765265 | Mark B. Kukler | Internal Medicine | 763 Old Norcross Rd, Lawrenceville, GA 30046-4317 | 2006-05-11 |
| 1205886504 | Southern Gastroenterology Associates, LLC | Internal Medicine | 763 Old Norcross Rd, Lawrenceville, GA 30045-4317 | 2006-05-10 |
| 1548210859 | Arvind A. Kulkarni | Internal Medicine | 763 Old Norcross Rd, Lawrenceville, GA 30046-4317 | 2006-05-10 |
| 1275583437 | Scott W. Schorr | Internal Medicine | 763 Old Norcross Rd, Lawrenceville, GA 30046-4317 | 2006-05-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285104315 | Shalanda Monique Booker | Counselor | 2940 Emerald Springs Drive, Lawrenceville, GA 30045 | 2018-12-02 |
| 1669957320 | Chantelle S Fuller | Behavioral Analyst | 805 Donington Cir, Lawrenceville, GA 30045 | 2018-09-28 |
| 1356836035 | Gad Health Care LLC | Home Health | 1140 Great Oaks Dr, Lawrenceville, GA 30045 | 2018-06-26 |
| 1346668662 | Eca Optical, LLC | Eyewear Supplier (Equipment, not the service) | 601-a Professional Drive, Ste 170, Lawrenceville, GA 30045 | 2014-04-03 |
| 1598102733 | Selena Fuller | Nurse Practitioner | 181 South Clayton Street, Lawrenceville, GA 30045 | 2013-05-29 |
| 1942555982 | Vida Michele James-bryant | Community Health Worker | 1309 Avington Glen Dr, Lawrenceville, GA 30045 | 2012-07-16 |
| 1770840639 | Rebecca Vinson D'angelo | Occupational Therapist | 1518 Great Shoals Cir, Lawrenceville, GA 30045 | 2012-04-17 |
| 1427346774 | Amanda Michelel Woods | Psychologist | 285 South Perry Street, Lawrenceville, GA 30045 | 2011-07-20 |
| 1790070563 | M & G Pharmacy Inc | Pharmacy | 100 Hurricane Shoals Rd Suite F, Lawrenceville, GA 30045 | 2011-06-09 |
| 1306146154 | Thanh Dau | Optometrist | 1250 Scenic Highway, Ste 1268, Lawrenceville, GA 30045 | 2010-10-27 |
| Find all providers in zip 30045 | ||||
| Taxonomy Code | 261QE0800X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Endoscopy |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194761908 | Gwinnett Endoscopy Center, PC | Clinic/Center | 301 Philip Blvd, Suite B, Lawrenceville, GA 30046-8745 | 2006-06-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376052928 | Newnan Endoscopy Center LLC | Clinic/Center | 1200 Lower Fayetteville Rd, Newnan, GA 30263 | 2017-09-27 |
| 1275871147 | Panola Endoscopy Center LLC | Clinic/Center | 5403 Hillandale Park Court, Suite A, Lithonia, GA 30058 | 2013-01-28 |
| 1760778765 | Gastrointestinal Diagnostic Endoscopy Woodstock, LLC | Clinic/Center | 118 Mill St, Suite 100, Woodstock, GA 30188-4879 | 2011-06-28 |
| 1558662858 | Athens Endoscopy, LLC | Clinic/Center | 21 Jefferson Pl Ste 2, Athens, GA 30601-1761 | 2010-11-03 |
| 1518127398 | Snooze, LLC | Clinic/Center | 307 Market Ct, Canton, GA 30114-4562 | 2008-06-14 |
| 1184714214 | Gainesville Endoscopy Center, LLC | Clinic/Center | 2324 Limestone Overlook Ste 200, Gainesville, GA 30501-7443 | 2006-10-12 |
| 1023102266 | Cobb Endoscopy Center LLC | Clinic/Center | 3969 South Cobb Dr, Suite 207, Smyrna, GA 30080 | 2006-10-03 |
| 1659384329 | Endoscopy Center LLC | Clinic/Center | 1139 Lexington Ave Ste B, Savannah, GA 31404 | 2006-08-14 |
| 1063458909 | Woodstock Endoscopy Center | Clinic/Center | 900 Towne Lake Pkwy Ste 310, Woodstock, GA 30189-1604 | 2006-06-21 |
| 1487639100 | North Fulton Diagnostic Gastrointestinal Center | Clinic/Center | 1340 Upper Hembree Rd, Roswell, GA 30076-0927 | 2005-12-15 |
| Find all providers with the same taxonomy | ||||
| City | LAWRENCEVILLE |
| Zip Code | 30045 |
Please comment or provide details below to improve the information on SOUTHERN ENDOSCOPY SUITE, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.