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Organization
GWINNETT CLINIC, LTD
Active
Organization
GWINNETT CLINIC, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEEP SHAH MD, MSC (AUTHORIZED OFFICIAL)
(770) 995-3300
Entity
Organization
Contact information
Practice address
475 PHILIP BLVD, LAWRENCEVILLE, GA 30046-8737
(770) 995-3300
(770) 995-3307
Mailing address
10600 MEDLOCK BRIDGE RD, DULUTH, GA 30097-8404
(770) 995-3300
(770) 995-3307
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
—
NULL
173000000X
Legal Medicine
—
—
207K00000X
Allergy & Immunology Physician
—
NULL
207K00000X
Allergy & Immunology Physician
—
—
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
NULL
207RC0000X
Cardiovascular Disease Physician
—
—
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
NULL
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
NULL
207X00000X
Orthopaedic Surgery Physician
—
—
2084N0400X
Neurology Physician
—
NULL
2084N0400X
Neurology Physician
—
—
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
—
NULL
2084S0012X
Sleep Medicine (Psychiatry & Neurology) Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
NULL
2085R0202X
Diagnostic Radiology Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
NULL
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
08/10/2006
Last updated
01/24/2023
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