Healthcare Provider Details

I. General information

NPI: 1679818991
Provider Name (Legal Business Name): GWINNETT HEART SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2012
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

766 WALTHER RD SUITE 100
LAWRENCEVILLE GA
30046-8764
US

IV. Provider business mailing address

766 WALTHER RD SUITE 100
LAWRENCEVILLE GA
30046-8764
US

V. Phone/Fax

Practice location:
  • Phone: 678-312-5625
  • Fax: 770-339-2120
Mailing address:
  • Phone: 678-312-5625
  • Fax: 770-339-2120

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: STEVEN A RUBIN
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 678-312-3050