Healthcare Provider Details

I. General information

NPI: 1811587868
Provider Name (Legal Business Name): ADULT SERVICES OF GWINNETT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2021
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 SATELLITE BLVD NE STE 202
SUWANEE GA
30024-7184
US

IV. Provider business mailing address

1703 WINDRUSH WAY
GRAYSON GA
30017-2806
US

V. Phone/Fax

Practice location:
  • Phone: 470-546-6798
  • Fax:
Mailing address:
  • Phone: 470-546-6798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHEQUANTA MYESHIA SCOTT
Title or Position: PROGRAM MANAGER
Credential:
Phone: 470-546-6798