Organization
SPORTS MEDICINE SOUTH OF GWINNETT LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORGE HERNANDEZ (VP/CCO)
(404) 851-8000
Entity
Organization
Contact information
Practice address
1900 RIVERSIDE PKWY, LAWRENCEVILLE, GA 30043-5925
(770) 237-3475
Mailing address
1001 SUMMIT BLVD STE 1000, BROOKHAVEN, GA 30319-6415
(404) 851-8000
Taxonomy
Speciality
Code
Description
License number
State
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
—
—
Other
Enumeration date
05/01/2020
Last updated
06/03/2025
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