Provider Demographics
NPI:1679818991
Name:GWINNETT HEART SPECIALISTS LLC
Entity Type:Organization
Organization Name:GWINNETT HEART SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-312-3050
Mailing Address - Street 1:766 WALTHER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8764
Mailing Address - Country:US
Mailing Address - Phone:678-312-5625
Mailing Address - Fax:770-339-2120
Practice Address - Street 1:766 WALTHER RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8764
Practice Address - Country:US
Practice Address - Phone:678-312-5625
Practice Address - Fax:770-339-2120
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GWINNETT MEDICAL GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-11-28
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty