1699395541 NPI number — MEDICI SURGICAL CENTER GWINNETT, LLC

Table of content: (NPI 1699395541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699395541 NPI number — MEDICI SURGICAL CENTER GWINNETT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICI SURGICAL CENTER GWINNETT, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699395541
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2911 GEORGE BUSBEE PKWY NW STE 50
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KENNESAW
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30144-6910
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-328-4624
Provider Business Mailing Address Fax Number:
770-882-2576

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2220 WISTERIA DR STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SNELLVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30078-4604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-328-4624
Provider Business Practice Location Address Fax Number:
770-882-2576
Provider Enumeration Date:
04/21/2020

Additional Information

Authorized Official

Authorized Official Last Name:
DOSANJH
Authorized Official First Name:
SONNY
Authorized Official Middle Name:
Authorized Official Title or Position:
CMO, OWNER
Authorized Official Telephone Number:
844-328-4624

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com