Provider Demographics
NPI:1972065852
Name:GWINNETT HOSPITAL SYSTEM TCCC LLC
Entity Type:Organization
Organization Name:GWINNETT HOSPITAL SYSTEM TCCC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VICE PRESIDENT/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:Y
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:678-312-4308
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:678-312-5527
Mailing Address - Fax:770-339-3459
Practice Address - Street 1:631 PROFESSIONAL DR STE 450
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3370
Practice Address - Country:US
Practice Address - Phone:770-963-8030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GWINNNETT HOSPITAL SYSTEM, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty