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General NPI Number Information
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NPI Number | 1811587868
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Entity Type | Organization
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Legal Business Name | ADULT SERVICES OF GWINNETT
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Dates
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Enumeration Date | 01/24/2021
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Last Update Date | 01/08/2026
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Provider Practice Location Address
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Address Line | 302 SATELLITE BLVD NE STE 202
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City | SUWANEE
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State | GA
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Zip | 30024-7184
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Country | US
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Telephone | 470-546-6798
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Fax |
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Provider Business Mailing Address
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Address Line | 1703 WINDRUSH WAY
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City | GRAYSON
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State | GA
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Zip | 30017-2806
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Country | US
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Telephone | 470-546-6798
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Fax |
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Authorized Official
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Title or Position | PROGRAM MANAGER
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Name | MRS. SHEQUANTA MYESHIA SCOTT
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Credential |
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Telephone | 470-546-6798
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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