Healthcare Provider Details

I. General information

NPI: 1821961582
Provider Name (Legal Business Name): GWINN ORTHODONTICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2025
Last Update Date: 09/27/2025
Certification Date: 09/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

956 KILLIAN HILL RD SW
LILBURN GA
30047-3103
US

IV. Provider business mailing address

956 KILLIAN HILL RD SW
LILBURN GA
30047-3103
US

V. Phone/Fax

Practice location:
  • Phone: 770-921-2233
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KARUNESH CHAKOTE
Title or Position: MEMBER
Credential: DMD
Phone: 516-474-7958