Healthcare Provider Details

I. General information

NPI: 1134434467
Provider Name (Legal Business Name): GWINNETT ORTHOPEDICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2010
Last Update Date: 08/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 TREE LN SUITE 140
SNELLVILLE GA
30078-2016
US

IV. Provider business mailing address

545 OLD NORCROSS RD SUITE 300
LAWRENCEVILLE GA
30046-3389
US

V. Phone/Fax

Practice location:
  • Phone: 770-963-6300
  • Fax: 678-287-1664
Mailing address:
  • Phone: 770-963-6300
  • Fax: 678-287-1664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number000000000
License Number StateGA

VIII. Authorized Official

Name: KEITH SOLINSKY
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 770-963-6300