Basic Information
| Provider Information | |||||||||
| NPI: | 1689097859 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | REDDY URGENT CARE-MONROE LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MONROE REDDY URGENT CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 529 | ||||||||
| Address2: | |||||||||
| City: | ROYSTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306620529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066217575 | ||||||||
| FaxNumber: | 7066217557 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 GREAT OAKS DR | ||||||||
| Address2: | SUITE 9 | ||||||||
| City: | MONROE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306558225 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7066217575 | ||||||||
| FaxNumber: | 7066217557 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2014 | ||||||||
| LastUpdateDate: | 05/15/2014 | ||||||||
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| AuthorizedOfficialLastName: | GORDON | ||||||||
| AuthorizedOfficialFirstName: | BRANDI | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7066217561 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.