Healthcare Provider Details

I. General information

NPI: 1073768800
Provider Name (Legal Business Name): GWINNETT MEDICAL ASSOCIATES,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2008
Last Update Date: 11/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 QUEEN CITY PKWY SUITE #106
GAINESVILLE GA
30501-4348
US

IV. Provider business mailing address

715 QUEEN CITY PKWY SUITE #106
GAINESVILLE GA
30501-4348
US

V. Phone/Fax

Practice location:
  • Phone: 770-531-5115
  • Fax: 770-531-5116
Mailing address:
  • Phone: 770-531-5115
  • Fax: 770-531-5116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number52073
License Number StateGA

VIII. Authorized Official

Name: RAHIM GUL
Title or Position: M.D., D.O.
Credential:
Phone: 770-531-5115