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NPI Code Detail

MEDICARE: GWINNETT BONE & JOINT SPECIALIST

MEDICARE: GWINNETT BONE & JOINT SPECIALIST
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
1207X00000XOrthopaedic Surgery PhysicianGA

General Provider Information

NPI Number : 1770688392
Entity Type Code : Organization
Provider Name (Legal Business Name) : GWINNETT BONE & JOINT SPECIALIST
Provider Business Mailing Address
First Line : 2400 WISTERIA DR
Second Line : SUITE A
City : SNELLVILLE
State : GA
Zip : 30078-2689
Country : US
Telephone Number : 404-296-5005
Fax Number : 404-296-5058
Provider Business Practice Location Address
First Line : 2400 WISTERIA DR
Second Line : SUITE A
City : SNELLVILLE
State : GA
Zip : 30078-2689
Country : US
Telephone Number : 404-296-5005
Fax Number : 404-296-5058
Authorized Official
Title or Position : BILLING MANAGER
Name : CHERA L HUDSON
Credential :
Telephone Number : 404-296-5005
Provider Enumeration Date : 09/14/2006
Last Update Date : 08/22/2020

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Directions to “GWINNETT BONE & JOINT SPECIALIST ” Practice Location

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