Healthcare Provider Details

I. General information

NPI: 1306185491
Provider Name (Legal Business Name): GWINNETT CARDIOLOGY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2013
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 WALTHER RD
LAWRENCEVILLE GA
30046-8725
US

IV. Provider business mailing address

1000 JOHNSON FERRY ROAD ATTN: JORGE HERNANDEZ
ATLANTA GA
30342-1170
US

V. Phone/Fax

Practice location:
  • Phone: 855-709-4535
  • Fax: 770-339-3459
Mailing address:
  • Phone: 404-851-6378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JORGE HERNANDEZ
Title or Position: VP ADMIN; CCO
Credential:
Phone: 404-851-6378