=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710037064
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENERAL SURGEONS OF GWINNETT, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2007
-----------------------------------------------------
Last Update Date | 07/11/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1800 TREE LN SUITE 330
-----------------------------------------------------
City | SNELLVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30078-4700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-978-0561
-----------------------------------------------------
Fax | 770-978-0546
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1800 TREE LN SUITE 330
-----------------------------------------------------
City | SNELLVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30078-4700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-978-0561
-----------------------------------------------------
Fax | 770-978-0546
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GORDON B WERBEL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 770-978-0561
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------