Healthcare Provider Details

I. General information

NPI: 1609244532
Provider Name (Legal Business Name): GWINNETT EMERGENCY SPECIALISTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 08/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 MEDICAL CENTER BLVD
LAWRENCEVILLE GA
30046-8708
US

IV. Provider business mailing address

500 MEDICAL CENTER BLVD
LAWRENCEVILLE GA
30046-8708
US

V. Phone/Fax

Practice location:
  • Phone: 678-312-3318
  • Fax: 678-312-4416
Mailing address:
  • Phone: 678-312-3318
  • Fax: 678-312-4416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberRN159452
License Number StateGA

VIII. Authorized Official

Name: KATHLEEN KONDAS
Title or Position: OFFICER
Credential:
Phone: 954-838-2371