Basic Information
| Provider Information | |||||||||
| NPI: | 1619966025 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | REDMOND PHYSICIAN PRACTICE COMPANY | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | REDMOND FAMILY CARE CENTER AT TRION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 160 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | TRION | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307531125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067347302 | ||||||||
| FaxNumber: | 7067347356 | ||||||||
| Practice Location | |||||||||
| Address1: | 160 CENTRAL AVE | ||||||||
| Address2: | |||||||||
| City: | TRION | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307531125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7067347302 | ||||||||
| FaxNumber: | 7067347356 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2005 | ||||||||
| LastUpdateDate: | 12/12/2007 | ||||||||
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| AuthorizedOfficialLastName: | LOCKE | ||||||||
| AuthorizedOfficialFirstName: | CHUCK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 6153737604 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.