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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
5595 PEACHTREE PKWY, NORCROSS, GA 30092-2551
(770) 242-8001
(770) 242-6279
Mailing address
10600 MEDLOCK BRIDGE RD, DULUTH, GA 30097-8404
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
—
NULL
173000000X
Legal Medicine
—
—
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine 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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