Healthcare Provider Details

I. General information

NPI: 1710049036
Provider Name (Legal Business Name): GWINNETT CONSULTANTS IN CARDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 04/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 PROFESSIONAL DRIVE STE 360
LAWRENCEVILLE GA
30046-0000
US

IV. Provider business mailing address

631 PROFESSIONAL DR STE 360
LAWRENCEVILLE GA
30046-3367
US

V. Phone/Fax

Practice location:
  • Phone: 770-962-4895
  • Fax: 770-962-4792
Mailing address:
  • Phone: 770-962-4895
  • Fax: 770-962-4792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. RACHEL A BAHIN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 770-962-4895