GDC Endoscopy Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

11C0001280 Issued in GA

Legal business name

GDC ENDOSCOPY CENTER LLC

Practice address

2887 Darlington Run
Duluth, GA 30097-4315

Phone

(678) 377-8252

Fax

(770) 963-0122

NPI assigned

Dec 22, 2006

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

Manager/Member

Phone

(678) 377-8252

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Listed as

GDC Endoscopy Center LLCCCN 11C0001280

Medicare certification status

ActiveFrom the Provider of Services file

Locations

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
  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": "1166745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709596800000",
    "number": "1811052749",
    "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": "300468737",
            "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": "2887 DARLINGTON RUN",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300974315",
            "telephone_number": "678-377-8252",
            "fax_number": "770-963-0122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GDC ENDOSCOPY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-22",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A",
        "authorized_official_last_name": "INDRAKRISHNAN",
        "authorized_official_first_name": "BHUVANENDRAM",
        "authorized_official_title_or_position": "MANAGER/MEMBER",
        "authorized_official_telephone_number": "678-377-8252",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "11C0001280",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "839960927A",
            "state": "GA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1598847618",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Leslie S Gaskill, M.D.
• Tametria Shyerell Gason
• Gathering Precious Stones LLC
• Adeola Adefowoju Gbenro, LPC
• GC Duluth Pediatrics, Inc.
• Lora M Gennardo
• Genova Diagnostics Inc
• Thomas E Geoghegan, DDS
• Vanessa George-King
• Brittany N. George

• Ambulatory Surgical Clinic/Center in Duluth, GA
• Providers in Duluth, GA by specialty
• Ambulatory Surgical Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2024; 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.