Provider Demographics
NPI:1588860050
Name:GWINNETT FAMILY PHYSICIANS
Entity Type:Organization
Organization Name:GWINNETT FAMILY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:ABRAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-932-0547
Mailing Address - Street 1:4585 NELSON BROGDON BLVD
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3466
Mailing Address - Country:US
Mailing Address - Phone:770-932-0547
Mailing Address - Fax:770-932-4035
Practice Address - Street 1:4585 NELSON BROGDON BLVD
Practice Address - Street 2:
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-3466
Practice Address - Country:US
Practice Address - Phone:770-932-0547
Practice Address - Fax:770-932-4035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA2005476208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08BBRWGMedicare ID - Type Unspecified
GAH78582Medicare UPIN
GAF96449Medicare UPIN
GA08BBRVQMedicare ID - Type Unspecified