Organization
GWINNETT CLINIC, LTD
Active
Other names
GWINNETT CLINIC , LTD
Organization subpart
No
Provider details
NPI number
Authorized official
DEEP SHAH MD, MSC (AUTHORIZED OFFICIAL)
(770) 995-3300
Entity
Organization
Contact information
Practice address
3475 PIEDMONT RD NE STE 1150, ATLANTA, GA 30305-3003
(770) 995-3300
(770) 995-3307
Mailing address
10600 MEDLOCK BRIDGE RD, DULUTH, GA 30097-8404
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
Other
Enumeration date
03/16/2012
Last updated
01/25/2023
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