Basic Information
Provider Information
NPI: 1235614074
EntityType: 2
ReplacementNPI:  
OrganizationName: BRASELTON URGENT CARE LLC
LastName:  
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Mailing Information
Address1: 6600 SUGARLOAF PARKWAY
Address2: STE. 400 MAILBOX 265
City: DULUTH
State: GA
PostalCode: 30097
CountryCode: US
TelephoneNumber: 6788215401
FaxNumber: 6788212210
Practice Location
Address1: 2620 OLD WINDER HWY
Address2: STE. 300
City: BRASELTON
State: GA
PostalCode: 305176103
CountryCode: US
TelephoneNumber: 6788212401
FaxNumber: 6788212210
Other Information
ProviderEnumerationDate: 09/27/2018
LastUpdateDate: 10/01/2021
NPIDeactivationReasonCode:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: DHAWAN
AuthorizedOfficialFirstName: SAURABH
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 6788212401
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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AuthorizedOfficialCredential: MD
NPICertificationDate: 10/01/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QU0200X  Y Ambulatory Health Care FacilitiesClinic/CenterUrgent Care

No ID Information.


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