Healthcare Provider Details

I. General information

NPI: 1316986227
Provider Name (Legal Business Name): CARTERSVILLE URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 06/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

824 WEST AVE
CARTERSVILLE GA
30120-6100
US

IV. Provider business mailing address

824 WEST AVE
CARTERSVILLE GA
30120-6100
US

V. Phone/Fax

Practice location:
  • Phone: 678-721-5570
  • Fax:
Mailing address:
  • Phone: 678-721-5570
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFF RYDBURG
Title or Position: VP
Credential:
Phone: 615-373-7600