Healthcare Provider Details

I. General information

NPI: 1316495021
Provider Name (Legal Business Name): GOOD SAMARITAN HEALTH CENTER OF GWINNETT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2016
Last Update Date: 09/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5949 BUFORD HWY
NORCROSS GA
30071-2472
US

IV. Provider business mailing address

5949 BUFORD HWY
NORCROSS GA
30071-2472
US

V. Phone/Fax

Practice location:
  • Phone: 678-280-6630
  • Fax: 678-280-6635
Mailing address:
  • Phone: 678-280-6630
  • Fax: 678-280-6635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. GREGORY E LANG
Title or Position: EXECUTIVE DIRECTOR
Credential: PHD
Phone: 678-280-6630