Healthcare Provider Details

I. General information

NPI: 1770723751
Provider Name (Legal Business Name): GWINNETT ENDOSCOPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 11/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 PLEASANT HILL RD SUITE 130
DULUTH GA
30096-1407
US

IV. Provider business mailing address

3855 PLEASANT HILL RD SUITE 130
DULUTH GA
30096-1407
US

V. Phone/Fax

Practice location:
  • Phone: 678-736-5201
  • Fax: 678-736-5241
Mailing address:
  • Phone: 678-736-5201
  • Fax: 678-736-5241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: J. THOMAS SHEPHERD
Title or Position: CHAIRMAN, GOVERNING BOARD
Credential:
Phone: 678-312-4521