# GWINNETT MEDICAL GROUP, INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Gwinnett Medical Services, Inc
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780747469
- **Authorized official:** MR. STEVEN A RUBIN (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (470) 325-0150

## Contact information

- **Practice address:** 1000 MEDICAL CENTER BLVD, LAWRENCEVILLE, GA 30046-7694
- **Practice address phone:** (678) 312-5525
- **Practice address fax:** (770) 339-2120
- **Mailing address:** PO BOX 116156, ATLANTA, GA 30368-6156
- **Mailing address phone:** (470) 325-0136
- **Mailing address fax:** (470) 325-0191

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | GA | — |
| 207R00000X | Internal Medicine Physician | — | GA | — |
| 207T00000X | Neurological Surgery Physician | — | GA | — |
| 208000000X | Pediatrics Physician | — | GA | — |
| 208600000X | Surgery Physician | — | GA | — |
| 208D00000X | General Practice Physician | — | GA | Yes |

## Other

- **Enumeration date:** 12/18/2006
- **Last updated:** 02/02/2015