Healthcare Provider Details

I. General information

NPI: 1083652713
Provider Name (Legal Business Name): GWINNETT HEALTH CENTERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3636 SATELLITE BLVD
DULUTH GA
30096
US

IV. Provider business mailing address

11877 DOUGLAS RD SUITE 102 267
ALPHARETTA GA
30005
US

V. Phone/Fax

Practice location:
  • Phone: 770-495-9100
  • Fax: 770-495-7757
Mailing address:
  • Phone: 770-495-9100
  • Fax: 770-495-7757

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number038370
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number007263
License Number StateGA

VIII. Authorized Official

Name: GEORGE W BEAUCHAMP II
Title or Position: CLINIC DIRECTOR
Credential: DC
Phone: 770-495-9100