Provider Demographics
NPI:1780151480
Name:EMBRACE OF GWINNETT
Entity type:Organization
Organization Name:EMBRACE OF GWINNETT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-755-7579
Mailing Address - Street 1:2992 MAIN ST W STE 104
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5735
Mailing Address - Country:US
Mailing Address - Phone:678-755-7579
Mailing Address - Fax:
Practice Address - Street 1:2992 MAIN ST W STE 104
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-5735
Practice Address - Country:US
Practice Address - Phone:678-755-7579
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies