Healthcare Provider Details

I. General information

NPI: 1780366237
Provider Name (Legal Business Name): GWINNETT PEDIACTRIC URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2023
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1170 MCKENDREE CHURCH RD
LAWRENCEVILLE GA
30043-5999
US

IV. Provider business mailing address

1170 MCKENDREE CHURCH RD
LAWRENCEVILLE GA
30043-5999
US

V. Phone/Fax

Practice location:
  • Phone: 770-299-1311
  • Fax:
Mailing address:
  • Phone: 770-299-1311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ADEBAYO AKINSOLA
Title or Position: OWNER
Credential: MD
Phone: 770-299-1311