Organization
GWINNETT SURGICAL ASSOCIATES, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WALLACE FORD MARTIN MD (MANAGING PARTNER)
(770) 962-9977
Entity
Organization
Contact information
Practice address
631 PROFESSIONAL DR, SUITE 300, LAWRENCEVILLE, GA 30046-3367
(770) 962-9977
(770) 339-9804
Mailing address
631 PROFESSIONAL DR, SUITE 300, LAWRENCEVILLE, GA 30046-3367
(770) 962-9977
(770) 339-9804
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Enumeration date
01/05/2011
Last updated
01/19/2012
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