NPIMap

Organization Active NPI

Gwinnett Clinic, LTD

  • Clinical Medical Laboratory
  • Lawrenceville, GA
National Provider Identifier
1609977198
Registry record updated Jan 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
GWINNETT CLINIC, LTD
Practice address
475 Philip Blvd Ste 301
Lawrenceville, GA 30046-8737
Phone
(678) 226-6203
Fax
(770) 995-3307
NPI assigned
Sep 26, 2006
Last updated
Jan 25, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 25, 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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X NU Primary

Addresses

Primary practice location

475 Philip Blvd Ste 301
Lawrenceville, GA 30046-8737

Mailing address

10600 Medlock Bridge Rd
Duluth, GA 30097-8404

Other identifiers 1

IdentifierTypeStateIssuer
11D1001114OtherGACLIA

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
11D0698009Gwinnett Clinic Lawrenceville475 Philip Boulevard, Lawrenceville, GA 30046Certificate of waiverAug 10, 2027
11D1001114Gwinnett Clinic LTD475 Philip Boulevard, Suite 301, Lawrenceville, GA 30046ComplianceFeb 10, 2027
11D2277856Gwinnett Digestive Clinic, PC475 Philip Boulevard, Suite 304, Lawrenceville, GA 30046Certificate of waiverMar 6, 2027

National Provider Directory

National Provider Directory
Tax ID family
JJ Shah MJ Shah MD PC7 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.

Locations

475 Philip Blvd
Ste 301
Lawrenceville, GA 30046
Phone (678) 226-6203

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674604800000",
    "number": "1609977198",
    "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": "475 PHILIP BLVD STE 301",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300468737",
            "telephone_number": "678-226-6203",
            "fax_number": "770-995-3307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GWINNETT CLINIC, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2023-01-25",
        "certification_date": "2023-01-25",
        "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": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "11D1001114",
            "state": "GA"
        }
    ],
    "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 25, 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.