Healthcare Provider Details

I. General information

NPI: 1417408576
Provider Name (Legal Business Name): LANIER URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 10/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1429 THOMPSON BRIDGE RD
GAINESVILLE GA
30501-1711
US

IV. Provider business mailing address

1300 PEACHTREE INDUSTRIAL BLVD STE 4101
SUWANEE GA
30024-4542
US

V. Phone/Fax

Practice location:
  • Phone: 770-831-5525
  • Fax:
Mailing address:
  • Phone: 770-831-5525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number59849
License Number StateGA

VIII. Authorized Official

Name: TRINA ALEXANDER
Title or Position: BILLING MANAGER
Credential:
Phone: 770-831-5525