Organization
GWINNETT PHYSICIAN GROUP, LLC
Active
Organization
GWINNETT PHYSICIAN GROUP, LLC
Active
Parent organization
NORTHSIDE HOSPITAL, INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
NORTHSIDE HOSPITAL, INC
Authorized official
AMY E FOUTS (CHIEF COMPLIANCE OFFICER)
(404) 851-6968
Entity
Organization
Contact information
Practice address
1000 MEDICAL CENTER BLVD, MOB 100 SUITE 210, LAWRENCEVILLE, GA 30046-7694
(855) 709-4535
(770) 339-2120
Mailing address
1000 JOHNSON FY RD NE, ATLANTA, GA 30342-1606
(404) 851-6378
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
Other
Enumeration date
08/11/2006
Last updated
05/18/2026
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