Healthcare Provider Details

I. General information

NPI: 1811097181
Provider Name (Legal Business Name): GWINNETT CENTER MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

748 OLD NORCROSS RD SUITE 185
LAWRENCEVILLE GA
30045-3393
US

IV. Provider business mailing address

748 OLD NORCROSS RD SUITE 185
LAWRENCEVILLE GA
30045-3393
US

V. Phone/Fax

Practice location:
  • Phone: 770-277-8554
  • Fax: 770-277-1799
Mailing address:
  • Phone: 770-277-8554
  • Fax: 770-277-1799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number039315
License Number StateGA

VIII. Authorized Official

Name: DR. CHRISTOPHER SCOTT CROOKER
Title or Position: OWNER
Credential: M.D.
Phone: 770-277-8554