Healthcare Provider Details

I. General information

NPI: 1457995045
Provider Name (Legal Business Name): REAGAN URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2019
Last Update Date: 12/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2878 FIVE FORKS TRICKUM RD STE 2A
LAWRENCEVILLE GA
30044
US

IV. Provider business mailing address

2878 FIVE FORKS TRICKUM RD STE 2A
LAWRENCEVILLE GA
30044-5896
US

V. Phone/Fax

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

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: SATISH PODDAR
Title or Position: CEO
Credential: MD
Phone: 678-344-8700