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General NPI Number Information
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NPI Number | 1588022438
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Entity Type | Organization
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Legal Business Name | GWINNETT FAMILY MEDICINE AND GERIATRICS
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Dates
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Enumeration Date | 02/08/2016
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Last Update Date | 02/08/2016
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Provider Practice Location Address
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Address Line | 706 GRAYSON HWY SUITE 215
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-5736
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Country | US
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Telephone | 770-316-2994
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Fax |
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Provider Business Mailing Address
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Address Line | 706 GRAYSON HWY SUITE 215
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-5736
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Country | US
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Telephone | 770-316-2994
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Fax |
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Authorized Official
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Title or Position | CEO/OWNER
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Name | WEZYANN GAYLE
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Credential | M.D.
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Telephone | 646-642-1564
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 11080875
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License Number State | GA
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