GWINNETT CENTER MEDICAL ASSOCIATES NPI 1326144734

NPI Information

GWINNETT CENTER MEDICAL ASSOCIATES is a medical physician assistant in Lawrenceville, GA. GWINNETT CENTER MEDICAL ASSOCIATES NPI is 1326144734. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

748 OLD NORCROSS RD
SUITE 185
LAWRENCEVILLE, GA
ZIP 30045-393
Phone: (770) 277-8554
Fax: (770) 277-1799

The provider's authorized official is Richard G Petit .
The authorized official title is Physician's Assistant and has the following contact phone number (770) 277-8554.

The CLIA number assigned to this NPI record is 11D1000578 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/15/2006 and was last updated on 8/22/2020.

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:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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