Provider Demographics
NPI:1316052566
Name:GWINNETT COUNTY BOARD OF COMMISSIONERS
Entity type:Organization
Organization Name:GWINNETT COUNTY BOARD OF COMMISSIONERS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT CHIEF - BUSINESS SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-518-4832
Mailing Address - Street 1:408 HURRICANE SHOALS RD NE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-4406
Mailing Address - Country:US
Mailing Address - Phone:678-518-4950
Mailing Address - Fax:678-518-4951
Practice Address - Street 1:408 HURRICANE SHOALS RD NE
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4406
Practice Address - Country:US
Practice Address - Phone:678-518-4950
Practice Address - Fax:678-518-4951
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GWINNETT COUNTY BOARD OF COMMISSIONERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-20
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA06707341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000387472AMedicaid
GA=========OtherBLUE CROSS BLUE SHIELD
GA=========OtherTRICARE
GA=========OtherTRICARE
GA85055159AAMedicare PIN