Healthcare Provider Details

I. General information

NPI: 1922365808
Provider Name (Legal Business Name): GWINNETT ADVANCED SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2012
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2306 WISTERIA DR STE 100
SNELLVILLE GA
30078-2658
US

IV. Provider business mailing address

1000 JOHNSON FERRY RD NE
ATLANTA GA
30342-1606
US

V. Phone/Fax

Practice location:
  • Phone: 770-979-8200
  • Fax:
Mailing address:
  • Phone: 404-851-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JORGE J HERNANDEZ
Title or Position: VP OF ADM SERVICES AND CCO
Credential:
Phone: 404-851-6968