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Organization

GASTROINTESTINAL ENDOSCOPY OF GWINNETT, P.C.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. ZACK ZEKE MARTIN (PRESIDENT CEO)
(770) 995-7989
Entity
Organization

Contact information

Practice address
600 PROFESSIONAL DR, STE 130, LAWRENCEVILLE, GA 30045-7651
(770) 995-7989
(770) 339-8646
Mailing address
600 PROFESSIONAL DR, STE 130, LAWRENCEVILLE, GA 30045-7651
(770) 995-7989
(770) 339-8646

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
111072
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00643365A
GA
01
4103
BLUE CROSS BLUE SHIELD
GA
Enumeration date
09/02/2005
Last updated
08/22/2020
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