Provider Demographics
NPI:1134390487
Name:ADULT PRIMARY CARE ASSOCIATES OF GREATER GWINNETT, LLC
Entity type:Organization
Organization Name:ADULT PRIMARY CARE ASSOCIATES OF GREATER GWINNETT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:SOBEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-513-2072
Mailing Address - Street 1:575 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 510
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-3333
Mailing Address - Country:US
Mailing Address - Phone:770-513-2072
Mailing Address - Fax:770-513-7986
Practice Address - Street 1:575 PROFESSIONAL DR
Practice Address - Street 2:SUITE 510
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-3333
Practice Address - Country:US
Practice Address - Phone:770-513-2072
Practice Address - Fax:770-513-7986
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty