Healthcare Provider Details

I. General information

NPI: 1972666253
Provider Name (Legal Business Name): REAGAN MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 10/04/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3685 BRASELTON HWY 100
DACULA GA
30019-5920
US

IV. Provider business mailing address

3685 BRASELTON HWY SUITE 100
DACULA GA
30019-5920
US

V. Phone/Fax

Practice location:
  • Phone: 678-546-9800
  • Fax: 678-344-8600
Mailing address:
  • Phone: 678-546-9800
  • Fax: 678-344-8700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: SATISH PODDAR
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 678-546-9800