Organization
GWINNETT MEDICAL SPECIALISTS LLC
Active
Organization
GWINNETT MEDICAL SPECIALISTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. OTIS L BONNER III (ATTORNEY)
(770) 485-1329
Entity
Organization
Contact information
Practice address
414 GLENLEAF DR, NORCROSS, GA 30092-6104
(720) 226-0652
Mailing address
414 GLENLEAF DR, NORCROSS, GA 30092-6104
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
—
GA
225100000X
Physical Therapist
—
GA
363L00000X
Nurse Practitioner
—
GA
Other
Enumeration date
06/21/2012
Last updated
06/21/2012
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