Basic Information
| Provider Information | |||||||||
| NPI: | 1679818991 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GWINNETT HEART SPECIALISTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 766 WALTHER RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300468764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6783125625 | ||||||||
| FaxNumber: | 7703392120 | ||||||||
| Practice Location | |||||||||
| Address1: | 766 WALTHER RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300468764 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6783125625 | ||||||||
| FaxNumber: | 7703392120 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2012 | ||||||||
| LastUpdateDate: | 12/10/2012 | ||||||||
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| AuthorizedOfficialLastName: | RUBIN | ||||||||
| AuthorizedOfficialFirstName: | STEVEN | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6783123050 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GWINNETT MEDICAL GROUP INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.