Provider Demographics
NPI:1003089418
Name:GWINNETT MULTI SPECIALTY GROUP LLC
Entity Type:Organization
Organization Name:GWINNETT MULTI SPECIALTY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-607-6565
Mailing Address - Street 1:3840 PEACHTREE INDUSTRIAL BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-4847
Mailing Address - Country:US
Mailing Address - Phone:770-670-6565
Mailing Address - Fax:770-670-6566
Practice Address - Street 1:3840 PEACHTREE INDUSTRIAL BOULEVARD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-4847
Practice Address - Country:US
Practice Address - Phone:770-670-6565
Practice Address - Fax:770-670-6566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-07
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA38545174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty