MEDICARE: GWINNETT CONVENIENT 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1891247896
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GWINNETT CONVENIENT CARE LLC

Provider Business Mailing Address
First Line	:	2148 DULUTH HWY
Second Line	:	SUITE 112
City	:	DULUTH
State	:	GA
Zip	:	30097-4506
Country	:	US
Telephone Number	:	770-820-1826
Fax Number	:

Provider Business Practice Location Address
First Line	:	1350 SCENIC HWY N STE 266
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-7924
Country	:	US
Telephone Number	:	470-436-8248
Fax Number	:	470-729-7562

Authorized Official
Title or Position	:	OWNER
Name	:	SYED S H ZAIDI
Credential	:	MD
Telephone Number	:	404-242-5666

Provider Enumeration Date	:	10/26/2016
Last Update Date	:	03/18/2024

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