Organization
GWINNETT CLINIC, LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEEP SHAH MD, MSC (AUTHORIZED OFFICIAL)
(770) 995-3300
Entity
Organization
Contact information
Practice address
475 PHILIP BLVD STE 301, LAWRENCEVILLE, GA 30046-8737
(678) 226-6203
(770) 995-3307
Mailing address
10600 MEDLOCK BRIDGE RD, DULUTH, GA 30097-8404
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11D1001114
CLIA
GA
Enumeration date
09/26/2006
Last updated
01/25/2023
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