Healthcare Provider Details

I. General information

NPI: 1235240623
Provider Name (Legal Business Name): GWINNETT ORTHOPEDICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 TERON TRCE HAMILTON MILL STATION
DACULA GA
30019-1662
US

IV. Provider business mailing address

2108 TERON TRCE HAMILTON MILL STATION
DACULA GA
30019-1662
US

V. Phone/Fax

Practice location:
  • Phone: 678-318-8020
  • Fax: 678-318-8025
Mailing address:
  • Phone: 678-318-8020
  • Fax: 678-318-8025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: HELLEN PENDLEY
Title or Position: PRACTICE MANAGER
Credential:
Phone: 770-963-6300