Organization
GDC ENDOSCOPY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BHUVANENDRAM INDRAKRISHNAN (MANAGER/MEMBER)
(678) 377-8252
Entity
Organization
Contact information
Practice address
2887 DARLINGTON RUN, DULUTH, GA 30097-4315
(678) 377-8252
(770) 963-0122
Mailing address
475 PHILIP BLVD, SUITE 304, LAWRENCEVILLE, GA 30046-8737
(678) 377-8252
(770) 963-0122
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
11C0001280
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1598847618
NPI
GA
05
—
839960927A
—
GA
Enumeration date
12/22/2006
Last updated
03/05/2024
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