NPIMap

Organization Active NPI

Greater Gwinnett Physician Practice Company

  • Family Medicine Physician
  • Lilburn, GA
National Provider Identifier
1891737425
Registry record updated Aug 29, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
GREATER GWINNETT PHYSICIAN PRACTICE COMPANY
Practice address
4120 Five Forks Trickum Rd SW
Suite 105
Lilburn, GA 30047-3130
Phone
(770) 921-6900
NPI assigned
Jun 11, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2007

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

Authorized official

Name
Chuck Locke
Title
VP
Phone
(800) 661-3365

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

4120 Five Forks Trickum Rd SW
Suite 105
Lilburn, GA 30047-3130

Mailing address

4120 Five Forks Trickum Rd SW
Suite 105
Lilburn, GA 30047-3130
Phone (770) 921-6900

Other names 1

  • Mountain East Family Medicine Doing business as

National Provider Directory

National Provider Directory

Locations

4120 Five Forks Trickum Rd SW
Ste 105
Lilburn, GA 30047
Phone (770) 921-6900

2160 Fountain Dr
Ste 122
Snellville, GA 30078
Phone (770) 982-2340

1192 Rockbridge Rd
Ste A
Stone Mtn, GA 30087
Phone (770) 925-2000

Practitioners & affiliated clinicians

Practitioners 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1149984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1188345600000",
    "number": "1891737425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4120 FIVE FORKS TRICKUM RD SW",
            "address_2": "SUITE 105",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300473130",
            "telephone_number": "770-921-6900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4120 FIVE FORKS TRICKUM RD SW",
            "address_2": "SUITE 105",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300473130",
            "telephone_number": "770-921-6900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREATER GWINNETT PHYSICIAN PRACTICE COMPANY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-11",
        "last_updated": "2007-08-29",
        "status": "A",
        "authorized_official_last_name": "LOCKE",
        "authorized_official_first_name": "CHUCK",
        "authorized_official_title_or_position": "VP",
        "authorized_official_telephone_number": "800-661-3365"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mountain East Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lilburn, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2007; 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.