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General NPI Number Information
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NPI Number | 1407988702
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Entity Type | Organization
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Legal Business Name | GWINNETT NEUROSURGICAL, PC
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 753 OLD NORCROSS RD SUITE A
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-4312
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Country | US
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Telephone | 770-995-5333
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Fax | 770-995-5322
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Provider Business Mailing Address
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Address Line | 753 OLD NORCROSS RD SUITE A
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City | LAWRENCEVILLE
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State | GA
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Zip | 30045-4312
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Country | US
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Telephone | 770-995-5333
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Fax | 770-995-5322
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Authorized Official
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Title or Position | MANAGER OF PATIENT ACCOUNTS
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Name | KEVIN L ANDERSON
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Credential |
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Telephone | 770-995-5333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State | GA
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