Provider Demographics
NPI:1619245107
Name:GWINNETT HOSPITAL SYSTEM, INC.
Entity Type:Organization
Organization Name:GWINNETT HOSPITAL SYSTEM, INC.
Other - Org Name:GWINNETT MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MARKETING ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOTTERAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-312-4333
Mailing Address - Street 1:1000 MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-7694
Mailing Address - Country:US
Mailing Address - Phone:678-312-1000
Mailing Address - Fax:770-682-2280
Practice Address - Street 1:1000 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7694
Practice Address - Country:US
Practice Address - Phone:678-312-1000
Practice Address - Fax:770-682-2280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation