MEDICARE: GWINNETT COUNTY BOARD OF COMMISSIONERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	06707	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316052566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GWINNETT COUNTY BOARD OF COMMISSIONERS

Provider Business Mailing Address
First Line	:	408 HURRICANE SHOALS RD NE
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-4406
Country	:	US
Telephone Number	:	678-518-4950
Fax Number	:	678-518-4951

Provider Business Practice Location Address
First Line	:	408 HURRICANE SHOALS RD NE
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-4406
Country	:	US
Telephone Number	:	678-518-4950
Fax Number	:	678-518-4951

Authorized Official
Title or Position	:	ASSISTANT CHIEF - BUSINESS SERVICES
Name	:	BRIAN WOLFE
Credential	:
Telephone Number	:	678-518-4832

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	12/28/2018

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Directions to “GWINNETT COUNTY BOARD OF COMMISSIONERS ” Practice Location

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