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NPI Code Detail

MEDICARE: SLEEP DISORDER CENTER @ GWINNETT CLINIC

MEDICARE: SLEEP DISORDER CENTER @ GWINNETT CLINIC
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
1261QS1200XSleep Disorder Diagnostic Clinic/Center
2173000000XLegal Medicine

General Provider Information

NPI Number : 1619242302
Entity Type Code : Organization
Provider Name (Legal Business Name) : SLEEP DISORDER CENTER @ GWINNETT CLINIC
Provider Business Mailing Address
First Line : 475 PHILIP BLVD
Second Line : STE 100
City : LAWRENCEVILLE
State : GA
Zip : 30046-8737
Country : US
Telephone Number : 770-995-3300
Fax Number : 770-995-3307
Provider Business Practice Location Address
First Line : 2650 LAWRENCEVILLE SUWANEE RD
Second Line : STE B
City : SUWANEE
State : GA
Zip : 30024-2535
Country : US
Telephone Number : 678-205-5000
Fax Number : 678-240-2080
Authorized Official
Title or Position : PRESIDENT
Name : DR. JAYENDRAKUMAR J SHAH
Credential : MD
Telephone Number : 770-995-3300
Provider Enumeration Date : 03/14/2012
Last Update Date : 07/12/2021

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Directions to “SLEEP DISORDER CENTER @ GWINNETT CLINIC ” Practice Location

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