Organization
COVENANT FAMILY MEDICINE GMG LLC
Active
Parent organization
GWINNETT MEDICAL GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
GWINNETT MEDICAL GROUP
Authorized official
MR. STEVEN A RUBIN (EXECUTIVE DIRECTOR)
(470) 325-0150
Entity
Organization
Contact information
Practice address
2098 TERON TRCE, SUITE 150, DACULA, GA 30019-1663
(678) 730-1620
Mailing address
2069 TERON TRCE, SUITE 100, DACULA, GA 30019-1665
(678) 730-1620
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
07/17/2012
Last updated
08/23/2013
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