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Organization
GWINNETT CLINIC, LTD
Active
Organization
GWINNETT CLINIC, LTD
Active
Other names
GWINNETT CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
DEEP SHAH MD, MSC (AUTHORIZED OFFICIAL)
(770) 995-3300
Entity
Organization
Contact information
Practice address
1383 ATLANTA HWY NW, AUBURN, GA 30011-3224
(678) 407-7891
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
261QP2300X
Primary Care Clinic/Center
—
NULL
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
11/11/2008
Last updated
01/25/2023
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