Gwinnett Advanced Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

GWINNETT ADVANCED SURGERY CENTER, LLC

Practice address

2306 Wisteria Dr Ste 100
Snellville, GA 30078-2658

Phone

(770) 979-8200

NPI assigned

Apr 18, 2012

Last updated

Nov 17, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jorge J Hernandez

Title

VP of Adm Services and Cco

Phone

(404) 851-6968

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Listed as

Gwinnett Advanced Surgery Center LLCCCN 11C0001012

Medicare certification status

ActiveFrom the Provider of Services file

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Northside Hospital, Inc.

  dba Diagnostic Clinic Oncology Pharmacy

  • Community/Retail Pharmacy
  • Gainesville, GA
  • NPI 1326679150

  Member Of

  NPD member

Locations

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

{
    "created_epoch": "1334707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700179200000",
    "number": "1922365808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 JOHNSON FERRY RD NE",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421606",
            "telephone_number": "404-851-8000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2306 WISTERIA DR STE 100",
            "city": "SNELLVILLE",
            "state": "GA",
            "postal_code": "300782658",
            "telephone_number": "770-979-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GWINNETT ADVANCED SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-18",
        "last_updated": "2023-11-17",
        "certification_date": "2023-11-17",
        "status": "A",
        "authorized_official_last_name": "HERNANDEZ",
        "authorized_official_first_name": "JORGE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "VP OF ADM SERVICES AND CCO",
        "authorized_official_telephone_number": "404-851-6968"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles Peguy Guillaume, PMHNP
• Nadia Guillaume, CNA
• Cristina Isabella Guldenschuh, A.A.
• Rahul Gupta, MD
• Gwen's #1 Caregiver Services LLC
• Gwinnett Bone & Joint Specialist
• Gwinnett Care at Home LLC
• Gwinnett Center for Outpatient Surgery LP
• Gwinnett Clinic, LTD
• Gwinnett Convenient Care LLC

• Ambulatory Surgical Clinic/Center in Snellville, GA
• Providers in Snellville, 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 Nov 17, 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.