SURGICARE GWINNETT NPI 1164833398

NPI Information

  • NPI: 1164833398
  • Provider Name: SURGICARE GWINNETT
  • Classification: Clinic/Center - 261QA1903X
  • Specialization: Ambulatory Surgical
  • Entity Type: Organization
  • CLIA Number: 11D2077870
  • Address: 367 ATHENS HWY
    BLD 100 SUITE B
    LOGANVILLE, GA
    ZIP 30052
  • Phone: (678) 466-6760

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NPI Details

SURGICARE GWINNETT is an ambulatory surgical clinic center in Loganville, GA. SURGICARE GWINNETT NPI is 1164833398. The provider is registered as an organization entity type.

The provider's business location address is:

367 ATHENS HWY
BLD 100 SUITE B
LOGANVILLE, GA
ZIP 30052-204
Phone: (678) 466-6760

The provider's authorized official is Christopher Ibikunle .
The authorized official title is Administrator and has the following contact phone number (678) 466-6760.

The CLIA number assigned to this NPI record is 11D2077870 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 5/9/2014 and was last updated on 5/20/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QA1903XClinic/CenterAmbulatory SurgicalYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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