1609388636 NPI number — UC URGENT CARE INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609388636 NPI number — UC URGENT CARE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UC URGENT CARE INC.
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:
Provider Other Organization Name Type Code:
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:
1609388636
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
217 MEDICAL WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVERDALE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30274-2522
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-897-7043
Provider Business Mailing Address Fax Number:
770-996-3529

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6781 LONDONDERRY WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UNION CITY
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30291-2094
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-897-7043
Provider Business Practice Location Address Fax Number:
770-996-3529
Provider Enumeration Date:
10/31/2017

Additional Information

Authorized Official

Authorized Official Last Name:
OBIEKWE
Authorized Official First Name:
ONWURA
Authorized Official Middle Name:
MICHAEL
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
770-897-7043

Provider Taxonomy Codes

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

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

  • Identifier: $$$$$$$$$ . This is a "SOCIAL SECURITY" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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