Healthcare Provider Details

I. General information

NPI: 1598801672
Provider Name (Legal Business Name): GWINNETT FAMILY MEDICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3725 ZOAR RD
SNELLVILLE GA
30039-6134
US

IV. Provider business mailing address

3725 ZOAR RD
SNELLVILLE GA
30039-6134
US

V. Phone/Fax

Practice location:
  • Phone: 770-979-1818
  • Fax: 770-736-7134
Mailing address:
  • Phone: 770-979-1818
  • Fax: 770-736-7134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number043346
License Number StateGA

VIII. Authorized Official

Name: LINDA L CASTEEL
Title or Position: OWNER
Credential: MD
Phone: 770-979-1818