Organization
SURGICARE GWINNETT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRISTOPHER IBIKUNLE (ADMINISTRATOR)
(678) 466-6760
Entity
Organization
Contact information
Practice address
367 ATHENS HWY, BLD 100 SUITE B, LOGANVILLE, GA 30052-2204
(678) 466-6760
Mailing address
367 ATHENS HWY, BLD 100 SUITE B, LOGANVILLE, GA 30052-2204
(678) 466-6760
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
05/09/2014
Last updated
05/20/2014
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