MEDICARE: GWINNETT MEDICAL LOGISTICS 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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1801712526
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GWINNETT MEDICAL LOGISTICS LLC

Provider Business Mailing Address
First Line	:	1930 CLINTON PL
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-3501
Country	:	US
Telephone Number	:	470-798-1399
Fax Number	:

Provider Business Practice Location Address
First Line	:	1930 CLINTON PL
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30043-3501
Country	:	US
Telephone Number	:	470-798-1399
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MARCELLOUS ISAIAH BARNES
Credential	:
Telephone Number	:	470-798-1399

Provider Enumeration Date	:	06/26/2026
Last Update Date	:	06/26/2026

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