Healthcare Provider Details

I. General information

NPI: 1720175169
Provider Name (Legal Business Name): GWINNETT COUNTY HEALTH DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 GRAYSON HWY
LAWRENCEVILLE GA
30045-7171
US

IV. Provider business mailing address

PO BOX 897
LAWRENCEVILLE GA
30046-0897
US

V. Phone/Fax

Practice location:
  • Phone: 770-339-4283
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: LLOYD M HOFER
Title or Position: DIRECTOR
Credential: MD MPH
Phone: 770-339-4260