Provider Demographics
NPI:1770723751
Name:GWINNETT ENDOSCOPY SERVICES, LLC
Entity type:Organization
Organization Name:GWINNETT ENDOSCOPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN, GOVERNING BOARD
Authorized Official - Prefix:
Authorized Official - First Name:J.
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SHEPHERD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-312-4521
Mailing Address - Street 1:3855 PLEASANT HILL RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-1407
Mailing Address - Country:US
Mailing Address - Phone:678-736-5201
Mailing Address - Fax:678-736-5241
Practice Address - Street 1:3855 PLEASANT HILL RD
Practice Address - Street 2:SUITE 130
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-1407
Practice Address - Country:US
Practice Address - Phone:678-736-5201
Practice Address - Fax:678-736-5241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy