GWINNETT MEDICAL GROUP, INC (NPI# 1780747469) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780747469 |
| Entity Type | Organization |
| Organization Name | GWINNETT MEDICAL GROUP, INC |
| Other Organization Name | GWINNETT MEDICAL SERVICES, INC |
| Practice Address |
1000 Medical Center Blvd Lawrenceville GA 30046-7694 |
| Mailing Address |
Po Box 116156 Atlanta GA 30368-6156 |
| Practice Telephone | 6783125525 |
| Practice Fax Number | 7703392120 |
| Mailing Telephone | 4703250136 |
| Mailing Fax Number | 4703250191 |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2015-02-02 |
| Authorized Official Name | MR. STEVEN A RUBIN (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 4703250150 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | GA | Allopathic & Osteopathic Physicians | |
| N | 207R00000X | Internal Medicine | GA | Allopathic & Osteopathic Physicians | |
| N | 207T00000X | Neurological Surgery | GA | Allopathic & Osteopathic Physicians | |
| N | 208600000X | Surgery | GA | Allopathic & Osteopathic Physicians | |
| N | 208000000X | Pediatrics | GA | Allopathic & Osteopathic Physicians | |
| Y | 208D00000X | General Practice | GA | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Gwinnett Medical Services, Inc | Former Legal Business Name - Organization |
| Street Address |
1000 MEDICAL CENTER BLVD |
| City | LAWRENCEVILLE |
| State | GA |
| Zip Code | 30046-7694 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942203757 | Peter J Kaplan | Specialist | 1000 Medical Center Blvd, Lawrenceville, GA 30045-7694 | 2005-05-24 |
| 1780281469 | Khatija Jivani | Pharmacist | 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 | 2020-10-06 |
| 1780298356 | Jennifer Nicole Venable | Anesthesiologist Assistant | 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 | 2020-09-01 |
| 1639782378 | Tehzeeb Babwani | Anesthesiologist Assistant | 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 | 2020-08-24 |
| 1801417480 | Northside Hospital Inc | Pharmacy | 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 | 2020-05-05 |
| 1851929996 | Mclean Davies | Student in an Organized Health Care Education/Training Program | 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 | 2020-04-01 |
| 1861029423 | Jaemi Chu | Internal Medicine | 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 | 2020-03-24 |
| 1548897267 | Sharul Saxena | Internal Medicine | 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 | 2020-03-24 |
| 1235766148 | Nahayo Esperant-hilaire | Student in an Organized Health Care Education/Training Program | 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 | 2020-03-23 |
| 1982239596 | Riley Claire Cullen | Nurse Practitioner | 1000 Medical Center Blvd, Lawrenceville, GA 30046-7694 | 2020-03-04 |
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| 1679060388 | Christopher Puckett | Student in an Organized Health Care Education/Training Program | 665 Duluth Hwy Suite 501, Lawrenceville, GA 30046 | 2018-04-18 |
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| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
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|---|---|---|---|---|
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| 1841233905 | Sylvia Marie Halleck | General Practice | 1431 Riverside Pkwy, Suite B, Lawrenceville, GA 30043-5946 | 2006-06-14 |
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| City | LAWRENCEVILLE |
| Zip Code | 30046 |
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| 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.