Basic Information
Provider Information | |||||||||
NPI: | 1104397728 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | REDDY URGENT CARE LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | CORNELIA REDDY URGENT CARE | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1061 DOWDY RD STE 101 | ||||||||
Address2: |   | ||||||||
City: | ATHENS | ||||||||
State: | GA | ||||||||
PostalCode: | 306065700 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7066217575 | ||||||||
FaxNumber: | 7066217557 | ||||||||
Practice Location | |||||||||
Address1: | 227 HABERSHAM VILLAGE CIR | ||||||||
Address2: |   | ||||||||
City: | CORNELIA | ||||||||
State: | GA | ||||||||
PostalCode: | 305315324 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7066217575 | ||||||||
FaxNumber: | 7066217557 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/07/2018 | ||||||||
LastUpdateDate: | 01/14/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | REDDY | ||||||||
AuthorizedOfficialFirstName: | RAM | ||||||||
AuthorizedOfficialMiddleName: | K | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 7066217575 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: | 01/14/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.