MEDICARE: GWINNETT CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	253Z00000X	In Home Supportive Care Agency

General Provider Information

NPI Number	:	1154258093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GWINNETT CARE LLC

Provider Business Mailing Address
First Line	:	3657 PARKSIDE CT
Second Line	:
City	:	PEACHTREE CORNERS
State	:	GA
Zip	:	30092-4522
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3657 PARKSIDE CT
Second Line	:
City	:	PEACHTREE CORNERS
State	:	GA
Zip	:	30092-4522
Country	:	US
Telephone Number	:	678-205-9136
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MIRANDA ISLJAMI
Credential	:
Telephone Number	:	678-205-9136

Provider Enumeration Date	:	05/05/2026
Last Update Date	:	05/05/2026

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