Provider Demographics
NPI:1598801672
Name:GWINNETT FAMILY MEDICAL CARE
Entity Type:Organization
Organization Name:GWINNETT FAMILY MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CASTEEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-979-1818
Mailing Address - Street 1:3725 ZOAR RD
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-6134
Mailing Address - Country:US
Mailing Address - Phone:770-979-1818
Mailing Address - Fax:770-736-7134
Practice Address - Street 1:3725 ZOAR RD
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30039-6134
Practice Address - Country:US
Practice Address - Phone:770-979-1818
Practice Address - Fax:770-736-7134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043346207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA05BBJHBMedicare ID - Type UnspecifiedMEDICARE PART B
GAE89359Medicare UPIN
GAS69390Medicare UPIN
GA08BBRVRMedicare ID - Type UnspecifiedMEDICARE PART B