Provider Demographics
NPI:1255125670
Name:GEORGIA INJURY CENTER OF LAWRENCEVILLE LLC
Entity type:Organization
Organization Name:GEORGIA INJURY CENTER OF LAWRENCEVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:JUTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-730-6240
Mailing Address - Street 1:3011 SUTTON GATE DR STE 210
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-5153
Mailing Address - Country:US
Mailing Address - Phone:678-730-6240
Mailing Address - Fax:678-730-1005
Practice Address - Street 1:359 W PIKE ST STE 190
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4843
Practice Address - Country:US
Practice Address - Phone:678-730-6240
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty