| Organization Name: | GWINNETT MEDICAL CENTER |
| NPI Number: | 1205239167 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CRISTINA MARIA BRADSTREET (CERTIFIED ATHLETIC TRAINER) |
| Mailing Address: | 1177 Charlie Ln Sw Lilburn |
| State: | GA US |
| Postal Code: | 300474203 |
| Phone Number: | 7702313203 |
| Fax Number: | |
| NPI Enumeration Date: | 10/06/2014 |
| NPI Last Update Date: | 10/06/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0400X |
| License Number: | AT00001479 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rehabilitation |
| Taxonomy Definition: | |