Healthcare Provider Details

I. General information

NPI: 1679621221
Provider Name (Legal Business Name): GWINNETT GENERAL MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 MCKENDREE CHURCH RD SUITE 204
LAWRENCEVILLE GA
30043-5207
US

IV. Provider business mailing address

1180 MCKENDREE CHURCH RD SUITE 204
LAWRENCEVILLE GA
30043-5207
US

V. Phone/Fax

Practice location:
  • Phone: 770-682-1717
  • Fax: 770-682-1723
Mailing address:
  • Phone: 770-682-1717
  • Fax: 770-682-1723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GARY A MCMORRIS
Title or Position: PRESIDENT
Credential: MD
Phone: 770-682-1717