NPIMap

Organization Active NPI

Gwinnett Clinic, LTD

  • Multi-Specialty Clinic/Center
  • Loganville, GA
National Provider Identifier
1255342630
Registry record updated Jan 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Multi-Specialty Clinic/CenterTaxonomy code 261QM1300X
Legal business name
GWINNETT CLINIC, LTD
Practice address
4397 Atlanta Hwy
Loganville, GA 30052-2642
Phone
(770) 554-0800
Fax
(770) 554-0080
NPI assigned
Aug 10, 2006
Last updated
Jan 24, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Deep Shah, MD, MSCNPI 1114361458
Title
Authorized Official
Phone
(770) 995-3300

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Multi-Specialty Clinic/Center 261QM1300X Primary
Nurse Practitioner 363L00000X
Legal Medicine 173000000X
Family Medicine Physician 207Q00000X
Internal Medicine Physician 207R00000X

Addresses

Primary practice location

4397 Atlanta Hwy
Loganville, GA 30052-2642

Mailing address

10600 Medlock Bridge Rd
Duluth, GA 30097-8404

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031104000266 GA Part B Supplier - Clinic/Group Practice 9436061801 Receives reassigned benefits from 47 practitioners
23 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Lilburn, GA; Logan, GA; Lawrenceville, GA; Monroe, GA; Norcross, GA; Snellville, GA; Suwanee, GA; Tucker, GA…

Other NPIs on the same Medicare enrollment 22

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 22

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D0954625Gwinnett Clinic Loganville4397 Atlanta Hwy, Loganville, GA 30052Certificate of waiverDec 2, 2026

National Provider Directory

National Provider Directory

Locations

4580 Nelson Brogdon Blvd
Buford, GA 30518
Phone (770) 831-6703

4397 Atlanta Hwy
Loganville, GA 30052
Phone (770) 554-0800

Practitioners & affiliated clinicians

Practitioners 28

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 28

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674518400000",
    "number": "1255342630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10600 MEDLOCK BRIDGE RD",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300978404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4397 ATLANTA HWY",
            "city": "LOGANVILLE",
            "state": "GA",
            "postal_code": "300522642",
            "telephone_number": "770-554-0800",
            "fax_number": "770-554-0080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GWINNETT CLINIC, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2023-01-24",
        "certification_date": "2023-01-24",
        "status": "A",
        "authorized_official_last_name": "SHAH",
        "authorized_official_first_name": "DEEP",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "770-995-3300",
        "authorized_official_credential": "MD, MSC"
    },
    "taxonomies": [
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "173000000X",
            "taxonomy_group": "",
            "desc": "Legal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loganville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.