Healthcare Provider Details

I. General information

NPI: 1831061522
Provider Name (Legal Business Name): GWINNETT PULMONARY & SLEEP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2025
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 PROFESSIONAL DR STE 350
LAWRENCEVILLE GA
30046-3370
US

IV. Provider business mailing address

631 PROFESSIONAL DR STE 350
LAWRENCEVILLE GA
30046-3370
US

V. Phone/Fax

Practice location:
  • Phone: 770-995-0630
  • Fax: 770-995-1555
Mailing address:
  • Phone: 770-995-0630
  • Fax: 770-995-1555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER THOMAS-ROLOFF
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 678-942-5985