Healthcare Provider Details

I. General information

NPI: 1649009705
Provider Name (Legal Business Name): GWINNETT PT PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 ATHENS HWY STE 112
GRAYSON GA
30017-1762
US

IV. Provider business mailing address

1142 ATHENS HWY STE 112
GRAYSON GA
30017-1762
US

V. Phone/Fax

Practice location:
  • Phone: 256-225-3085
  • Fax:
Mailing address:
  • Phone: 256-225-3085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. SHEIV KUMAR
Title or Position: MANAGING PARTNER
Credential:
Phone: 256-225-3085