Provider Demographics
NPI:1669653002
Name:NORTH GWINNETT PRIMARY CARE
Entity Type:Organization
Organization Name:NORTH GWINNETT PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGENDRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-714-2070
Mailing Address - Street 1:PO BOX 993
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-0018
Mailing Address - Country:US
Mailing Address - Phone:678-612-1994
Mailing Address - Fax:
Practice Address - Street 1:2098 TERON TRCE
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1663
Practice Address - Country:US
Practice Address - Phone:678-714-2070
Practice Address - Fax:678-714-2070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA42336261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care