Healthcare Provider Details

I. General information

NPI: 1871031625
Provider Name (Legal Business Name): GWINNNETT HOSPITAL SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2017
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 DULUTH HWY SUITE 501
LAWRENCEVILLE GA
30046-8709
US

IV. Provider business mailing address

PO BOX 1190
LAWRENCEVILLE GA
30046-1190
US

V. Phone/Fax

Practice location:
  • Phone: 678-312-0470
  • Fax:
Mailing address:
  • Phone: 678-312-0470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT E. OREM
Title or Position: VP FINANCE
Credential:
Phone: 678-312-5633