Provider Demographics
NPI:1700901311
Name:GASTROENTEROLOGY SPECIALISTS OF GWINNETT, P.C.
Entity Type:Organization
Organization Name:GASTROENTEROLOGY SPECIALISTS OF GWINNETT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACK
Authorized Official - Middle Name:Z
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-995-7989
Mailing Address - Street 1:721 WELLNESS WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3304
Mailing Address - Country:US
Mailing Address - Phone:770-995-7989
Mailing Address - Fax:770-339-8646
Practice Address - Street 1:721 WELLNESS WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3304
Practice Address - Country:US
Practice Address - Phone:770-995-7989
Practice Address - Fax:770-339-8646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP1657Medicare ID - Type UnspecifiedGROUP NUMBER