PET IMAGING CENTER OF GWINNETT LLC (NPI# 1750699005) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750699005 |
| Entity Type | Organization |
| Organization Name | PET IMAGING CENTER OF GWINNETT LLC |
| Other Organization Name | TRIDENT MEDICAL IMAGING- GWINNETT |
| Practice Address |
555 Old Norcross Rd 115 Lawrenceville GA 30046-8716 |
| Mailing Address |
1275 Highway 54 W 103 Fayetteville GA 30214-4549 |
| Practice Telephone | 7702770501 |
| Practice Fax Number | 7702774324 |
| Mailing Telephone | 7706921387 |
| Mailing Fax Number | 7706922373 |
| Enumeration Date | 2010-09-21 |
| Last Update Date | 2010-09-21 |
| Authorized Official Name | CRYSTAL GATES (DIRECTOR OF PATIENT ACCOUNTS) |
| Authorized Official Telephone | 7706921387 |
| Is Organization Subpart | Y |
| Parent Organization Name | TRIDENT MEDICAL IMAGING |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR0200X |
Clinic/Center Specialization: Radiology |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Trident Medical Imaging- Gwinnett | Doing Business As Name - Organization |
| Street Address |
555 OLD NORCROSS RD 115 |
| City | LAWRENCEVILLE |
| State | GA |
| Zip Code | 30046-8716 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750329306 | Tlc for Women | Obstetrics & Gynecology | 555 Old Norcross Rd, Suite 250, Lawrenceville, GA 30045-8716 | 2006-06-04 |
| 1831583277 | Clear Choice Family Medicine, Inc | Family Medicine | 555 Old Norcross Rd, Suite 100, Lawrenceville, GA 30046-8716 | 2015-03-24 |
| 1184889735 | Michelle Mahajan | Nurse Practitioner | 555 Old Norcross Rd, Suite 210, Lawrenceville, GA 30045-8716 | 2008-07-23 |
| 1548388697 | Complete Physical Therapy & Diagnostic Center, LLC | Physical Medicine & Rehabilitation | 555 Old Norcross Rd, Suite 100, Lawrenceville, GA 30045-8716 | 2007-03-27 |
| 1154449486 | Family Medical Center of Ne Georgia,llc | Family Medicine | 555 Old Norcross Rd, Suite 100, Lawrenceville, GA 30045-8716 | 2007-03-26 |
| 1881725620 | Jean Young Song | Pediatrics | 555 Old Norcross Rd, Suite 210, Lawrenceville, GA 30045-8716 | 2007-03-07 |
| 1104960301 | Emmanuel Eze Mordi | Pediatrics | 555 Old Norcross Rd, Suite 210, Lawrenceville, GA 30045-8716 | 2007-02-19 |
| 1730223934 | Divya Biren Joshi | Pediatrics | 555 Old Norcross Rd, Suite 210, Lawrenceville, GA 30046-8716 | 2007-02-19 |
| 1366598799 | Anita Singh Khichi | Pediatrics | 555 Old Norcross Rd, Suite 210, Lawrenceville, GA 30046-8716 | 2007-01-26 |
| 1225184658 | Guna P Sekar | Pediatrics | 555 Old Norcross Rd, Ste 210, Lawrenceville, GA 30046-8716 | 2007-01-26 |
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| 1215550264 | Mesun Health Services, Inc | Skilled Nursing Facility | 88 Johnson Rd. Building #2, Lawrenceville, GA 30046 | 2020-05-26 |
| 1306499785 | Bryan Acosta | Chiropractor | 471 Scenic Hwy South, Lawrenceville, GA 30046 | 2019-07-24 |
| 1205308616 | Belle Lumiere Cosmetics LLC | Dermatology | 753 Old Norcross Road, Lawrenceville, GA 30046 | 2018-12-24 |
| 1548730179 | Alexis Nicole Robinson | Nurse Anesthetist, Certified Registered | 1000 Medical Center Boulevard, Lawrenceville, GA 30046 | 2018-11-27 |
| 1679060388 | Christopher Puckett | Student in an Organized Health Care Education/Training Program | 665 Duluth Hwy Suite 501, Lawrenceville, GA 30046 | 2018-04-18 |
| 1457851255 | Advanced Urology Institute of Georgia | Urology | 501 Crown Point Way, Lawrenceville, GA 30046 | 2018-02-19 |
| 1013447044 | Pharmacy Investments of Lawrenceville, LLC | Pharmacy | 738 Old Norcross Road, Ste A, Lawrenceville, GA 30046 | 2017-06-13 |
| 1225577000 | Priority Housecalls LLC | Clinic/Center | 225 Scenic Hwy, Ste 200, Lawrenceville, GA 30046 | 2017-02-14 |
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| Taxonomy Code | 261QR0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Radiology |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851324529 | Georgia Health Imaging | Clinic/Center | 3653 Lawrenceville Hwy, Suite 150, Lawrenceville, GA 30044-4107 | 2006-07-08 |
| 1467437327 | American Health Imaging of Ga LLC | Clinic/Center | 481 W Pike St, Lawrenceville, GA 30046-3245 | 2005-12-13 |
| 1720512635 | Avvc Medical, LLC | Clinic/Center | 600 Professional Dr, Lawrenceville, GA 30046-7651 | 2017-04-18 |
| 1538546114 | Atlanta Vascular and Vein Center, LLC | Clinic/Center | 600 Professional Dr, Suite 160a, Lawrenceville, GA 30046-7651 | 2015-05-02 |
| 1336386770 | Georgia Health Imaging, LLC | Clinic/Center | 3653 Lawrenceville Hwy, Suite 150, Lawrenceville, GA 30044-4107 | 2009-01-07 |
| 1457523722 | Georgia Diagnostic Centers | Clinic/Center | 2878 Five Forks Trickum Rd, Suite 1a, Lawrenceville, GA 30044-5896 | 2008-03-27 |
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| 1952948291 | Catching Point Physician Centers, LLC | Clinic/Center | 3333 Old Milton Pkwy Ste G100, Alpharetta, GA 30005-0008 | 2019-12-05 |
| 1447802780 | American Health Imaging of Ga LLC | Clinic/Center | 2851 Washington Rd, Augusta, GA 30909-2131 | 2019-07-16 |
| 1700445582 | American Health Imaging of Ga LLC | Clinic/Center | 4374 Atlanta Hwy Ste 125, Hiram, GA 30141-1852 | 2019-06-06 |
| 1508425380 | American Health Imaging of Ga LLC | Clinic/Center | 796 Church St Ne Ste 100, Marietta, GA 30060-7228 | 2019-06-06 |
| 1588229918 | Synergy Radiology, LLC | Clinic/Center | 6025 Professional Pkwy Ste 104, Douglasville, GA 30134-5610 | 2019-05-01 |
| 1134645351 | M & B Imaging, PC | Clinic/Center | 2485 Jefferson Rd, Athens, GA 30607-1202 | 2017-08-18 |
| 1548785330 | American Health Imaging of Georgia LLC | Clinic/Center | 1103 Fountain Lake Dr, Brunswick, GA 31525-3039 | 2017-08-14 |
| 1164966461 | Pro Radiology, LLC | Clinic/Center | 60 Peachtree Park Dr Ne, Atlanta, GA 30309-1304 | 2016-12-06 |
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| City | LAWRENCEVILLE |
| Zip Code | 30046 |
Please comment or provide details below to improve the information on PET IMAGING CENTER OF GWINNETT LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.