NPIMap

Organization Active NPI

Gwinnett Surgical Associates, LLP

  • Surgery Physician
  • Lawrenceville, GA
National Provider Identifier
1396049383
Registry record updated Jan 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
Legal business name
GWINNETT SURGICAL ASSOCIATES, LLP
Practice address
631 Professional Dr
Suite 300
Lawrenceville, GA 30046-3367
Phone
(770) 962-9977
Fax
(770) 339-9804
NPI assigned
Jan 5, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 19, 2012

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

Authorized official

Name
Dr. Wallace Ford Martin, MD
Title
Managing Partner
Phone
(770) 962-9977

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208600000X Primary

Addresses

Primary practice location

631 Professional Dr
Suite 300
Lawrenceville, GA 30046-3367

Mailing address

631 Professional Dr
Suite 300
Lawrenceville, GA 30046-3367
Phone (770) 962-9977

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1294185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1326931200000",
    "number": "1396049383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "631 PROFESSIONAL DR",
            "address_2": "SUITE 300",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463367",
            "telephone_number": "770-962-9977",
            "fax_number": "770-339-9804"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "631 PROFESSIONAL DR",
            "address_2": "SUITE 300",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463367",
            "telephone_number": "770-962-9977",
            "fax_number": "770-339-9804"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GWINNETT SURGICAL ASSOCIATES, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-05",
        "last_updated": "2012-01-19",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "WALLACE",
        "authorized_official_middle_name": "FORD",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "770-962-9977",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.