1093847444 NPI number — REDDY URGENT CARE - ROYSTON LLC

Table of content: (NPI 1093847444)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093847444 NPI number — REDDY URGENT CARE - ROYSTON LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
REDDY URGENT CARE - ROYSTON LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ROYSTON REDDY URGENT CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093847444
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1061 DOWDY RD STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30606-5700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-621-7575
Provider Business Mailing Address Fax Number:
706-621-7557

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
132 FRANKLIN SPRINGS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROYSTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30662-4134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-245-7371
Provider Business Practice Location Address Fax Number:
706-245-9257
Provider Enumeration Date:
03/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
REDDY
Authorized Official First Name:
RAM
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
706-621-7575

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 113885 . This is a "MEDICARE PTAN #- RHC" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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