Gwinnett Digestive Clinic, PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

042289 Issued in GA

Legal business name

GWINNETT DIGESTIVE CLINIC, PC

Practice address

475 Philip Blvd
Suite 304
Lawrenceville, GA 30045-8732

Phone

(678) 377-8252

Fax

(770) 963-0122

NPI assigned

Feb 14, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Bhuvanendram IndrakrishnanNPI 1598847618

Title

MD

Phone

(678) 377-8252

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Practitioners 2

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

• Bhuvanendram Indrakrishnan, M.D.

  • Gastroenterology Physician
  • Lawrenceville, GA
  • NPI 1598847618
  Medicare reassignment NPD Authorized official
• Bennett Howard Bruckner, M.D.

  • Gastroenterology Physician
  • Spartanburg, SC
  • NPI 1639270622
  NPD (past)

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

{
    "created_epoch": "1171411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673395200000",
    "number": "1497898381",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 PHILIP BLVD",
            "address_2": "SUITE 304",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300458732",
            "telephone_number": "678-377-8252",
            "fax_number": "770-963-0122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 PHILIP BLVD",
            "address_2": "SUITE 304",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300458732",
            "telephone_number": "678-377-8252",
            "fax_number": "770-963-0122"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "475 Philip Blvd",
            "address_2": "Suite 304",
            "address_purpose": "LOCATION",
            "city": "Lawrenceville",
            "state": "GA",
            "postal_code": "300458732",
            "country_code": "US",
            "telephone_number": "678-377-8252",
            "fax_number": "770-963-0122",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GWINNETT DIGESTIVE CLINIC, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-14",
        "last_updated": "2023-01-11",
        "certification_date": "2023-01-11",
        "status": "A",
        "authorized_official_last_name": "INDRAKRISHNAN",
        "authorized_official_first_name": "BHUVANENDRAM",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "678-377-8252",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": "042289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gwinnett County Health Department
• Gwinnett County Health Department
• Gwinnett County Health Department
• Gwinnett Dental Care Lawrenceville LLC
• Gwinnett Denture Center PC
• Gwinnett Drugs LLC
• Gwinnett Drugs LLC
• Gwinnett Emergency Specialists Observation Services, LLC
• Gwinnett Emergency Specialists, LLC
• Gwinnett Emergency Specialists, P.C.

• Specialist in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.