NPIMap

Organization Active NPI

Gwinnett Clinic, LTD

  • Diagnostic Radiology Physician
  • Atlanta, GA
National Provider Identifier
1952676496
Registry record updated Jan 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
GWINNETT CLINIC, LTD
Doing business as
GWINNETT CLINIC , LTD
Practice address
3475 Piedmont Rd NE Ste 1150
Atlanta, GA 30305-3003
Phone
(770) 995-3300
Fax
(770) 995-3307
NPI assigned
Mar 16, 2012
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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Legal MedicineGroup: 193200000X MULTI-SPECIALTY GROUP 173000000X
Diagnostic Radiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2085R0202X Primary
Multi-Specialty Clinic/Center 261QM1300X

Addresses

Primary practice location

3475 Piedmont Rd NE Ste 1150
Atlanta, GA 30305-3003

Mailing address

10600 Medlock Bridge Rd
Duluth, GA 30097-8404

Other names 1

  • GWINNETT CLINIC , LTD Doing business as

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

National Provider Directory

National Provider Directory
Tax ID family
Gwinnett Clinic LTD7 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.

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1331856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1674604800000",
    "number": "1952676496",
    "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": "3475 PIEDMONT RD NE STE 1150",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303053003",
            "telephone_number": "770-995-3300",
            "fax_number": "770-995-3307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GWINNETT CLINIC, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-16",
        "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": "173000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Legal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QM1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Multi-Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GWINNETT CLINIC , LTD",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GWINNETT CLINIC , LTD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Atlanta, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.