Provider Demographics
NPI:1073768800
Name:GWINNETT MEDICAL ASSOCIATES,INC
Entity Type:Organization
Organization Name:GWINNETT MEDICAL ASSOCIATES,INC
Other - Org Name:GAINESVILLE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:M.D., D.O.
Authorized Official - Prefix:
Authorized Official - First Name:RAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:GUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-531-5115
Mailing Address - Street 1:715 QUEEN CITY PKWY
Mailing Address - Street 2:SUITE #106
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-4348
Mailing Address - Country:US
Mailing Address - Phone:770-531-5115
Mailing Address - Fax:770-531-5116
Practice Address - Street 1:715 QUEEN CITY PKWY
Practice Address - Street 2:SUITE #106
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-4348
Practice Address - Country:US
Practice Address - Phone:770-531-5115
Practice Address - Fax:770-531-5116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-20
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA52073207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA189134074BMedicaid
GA189134074AMedicaid
GAH11234Medicare UPIN