MEDICARE: GWINNETT COUNTY HEALTH DEPARTMENT

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	251K00000X	Public Health or Welfare Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912078627
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GWINNETT COUNTY HEALTH DEPARTMENT

Provider Business Mailing Address
First Line	:	PO BOX 897
Second Line	:
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-0897
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5030 GEORGIA BELLE CT
Second Line	:
City	:	NORCROSS
State	:	GA
Zip	:	30093-2667
Country	:	US
Telephone Number	:	770-638-5700
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	LLOYD M HOFER
Credential	:	MD MPH
Telephone Number	:	770-339-4260

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	06/16/2008

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