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Organization
GWINNETT SUPPLY COMPANY LLC
Active
Organization
GWINNETT SUPPLY COMPANY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KIRTI K SHAH M.D. (MEDICAL DIRECTOR)
(770) 962-1231
Entity
Organization
Contact information
Practice address
605 OLD NORCROSS RD, LAWRENCEVILLE, GA 30046-4315
(770) 962-1231
(770) 513-2107
Mailing address
605 OLD NORCROSS RD, LAWRENCEVILLE, GA 30046-4315
(770) 962-1231
(770) 513-2107
Taxonomy
Speciality
Code
Description
License number
State
332BD1200X
Dialysis Equipment & Supplies (DME)
Primary
—
NULL
Other
Enumeration date
06/27/2007
Last updated
02/27/2019
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