# GWINNETT MEDICAL SPECIALISTS LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1316200579
- **Authorized official:** MR. OTIS L BONNER III (ATTORNEY)
- **Authorized official phone:** (770) 485-1329

## Contact information

- **Practice address:** 414 GLENLEAF DR, NORCROSS, GA 30092-6104
- **Practice address phone:** (720) 226-0652
- **Mailing address:** 414 GLENLEAF DR, NORCROSS, GA 30092-6104

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | GA | Yes |
| 225100000X | Physical Therapist | — | GA | — |
| 363L00000X | Nurse Practitioner | — | GA | — |

## Other

- **Enumeration date:** 06/21/2012
- **Last updated:** 06/21/2012