Provider Demographics
NPI:1619242302
Name:SLEEP DISORDER CENTER @ GWINNETT CLINIC
Entity Type:Organization
Organization Name:SLEEP DISORDER CENTER @ GWINNETT CLINIC
Other - Org Name:GWINNETT CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYENDRAKUMAR
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-995-3300
Mailing Address - Street 1:475 PHILIP BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8737
Mailing Address - Country:US
Mailing Address - Phone:770-995-3300
Mailing Address - Fax:770-995-3307
Practice Address - Street 1:2650 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:STE B
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2535
Practice Address - Country:US
Practice Address - Phone:678-205-5000
Practice Address - Fax:678-240-2080
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GWINNETT CLINIC, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-14
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder DiagnosticGroup - Multi-Specialty