Healthcare Provider Details

I. General information

NPI: 1477873263
Provider Name (Legal Business Name): MD URGENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2010
Last Update Date: 06/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3515 CAMP CREEK PARKWAY STE 110
EAST POINT GA
30344-8140
US

IV. Provider business mailing address

2076 ASGARD CT NE
ATLANTA GA
30345-3889
US

V. Phone/Fax

Practice location:
  • Phone: 404-579-4124
  • Fax:
Mailing address:
  • Phone: 404-579-4124
  • Fax: 404-325-7955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THERESA FOSTER
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 815-713-2600