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General NPI Number Information
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NPI Number | 1609244532
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Entity Type | Organization
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Legal Business Name | GWINNETT EMERGENCY SPECIALISTS, P.C.
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Dates
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Enumeration Date | 09/09/2015
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Last Update Date | 08/27/2019
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Provider Practice Location Address
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Address Line | 500 MEDICAL CENTER BLVD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8708
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Country | US
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Telephone | 678-312-3318
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Fax | 678-312-4416
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Provider Business Mailing Address
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Address Line | 500 MEDICAL CENTER BLVD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-8708
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Country | US
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Telephone | 678-312-3318
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Fax | 678-312-4416
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Authorized Official
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Title or Position | OFFICER
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Name | KATHLEEN KONDAS
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Credential |
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Telephone | 954-838-2371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC2000X
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Taxonomy Name | Children's Hospital
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License Number | RN159452
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License Number State | GA
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