NPIMap

Organization Active NPI

Gwinnett Clinic, LTD

  • Multi-Specialty Clinic/Center
  • Monroe, GA
National Provider Identifier
1366453771
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
1390 W Spring St
Monroe, GA 30655-1759
Phone
(770) 266-6191
Fax
(770) 266-6707
NPI assigned
Aug 10, 2006
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, MSC
Title
Authorized Official
Phone
(770) 995-3300

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Legal MedicineGroup: 193200000X MULTI-SPECIALTY GROUP 173000000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Multi-Specialty Clinic/Center 261QM1300X Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

1390 W Spring St
Monroe, GA 30655-1759

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
11D1003564Gwinnett Clinic, LTD1390 West Spring Street, Monroe, GA 30655Certificate of waiverApr 24, 2027

National Provider Directory

National Provider Directory
Tax ID family
Gwinnett Clinic LTD7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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": "1366453771",
    "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": "1390 W SPRING ST",
            "city": "MONROE",
            "state": "GA",
            "postal_code": "306551759",
            "telephone_number": "770-266-6191",
            "fax_number": "770-266-6707"
        }
    ],
    "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": "173000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Legal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, 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.