Provider Demographics
NPI:1083652713
Name:GWINNETT HEALTH CENTERS LLC
Entity Type:Organization
Organization Name:GWINNETT HEALTH CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:BEAUCHAMP
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:770-495-9100
Mailing Address - Street 1:11877 DOUGLAS RD
Mailing Address - Street 2:SUITE 102 267
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005
Mailing Address - Country:US
Mailing Address - Phone:770-495-9100
Mailing Address - Fax:770-495-7757
Practice Address - Street 1:3636 SATELLITE BLVD
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096
Practice Address - Country:US
Practice Address - Phone:770-495-9100
Practice Address - Fax:770-495-7757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA007263111N00000X
GA0383702083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Not Answered2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G58622Medicare UPIN