Healthcare Provider Details

I. General information

NPI: 1982634572
Provider Name (Legal Business Name): GWINNETT HOSPITAL SYSTEM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 SCENIC HWY
LAWRENCEVILLE GA
30045-5675
US

IV. Provider business mailing address

PO BOX 1190
LAWRENCEVILLE GA
30046-1190
US

V. Phone/Fax

Practice location:
  • Phone: 678-442-5622
  • Fax: 770-339-3459
Mailing address:
  • Phone: 678-442-5622
  • Fax: 770-339-3459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number067-460
License Number StateGA

VIII. Authorized Official

Name: MR. THOMAS Y MCBRIDE III
Title or Position: SR. VP., CHIEF FINANCIAL OFFICER
Credential:
Phone: 678-442-4308