Healthcare Provider Details

I. General information

NPI: 1447249842
Provider Name (Legal Business Name): REDMOND PHYSICIAN PRACTICE COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3138 MAPLE RD SE
LINDALE GA
30147-1309
US

IV. Provider business mailing address

3138 MAPLE RD SE
LINDALE GA
30147-1309
US

V. Phone/Fax

Practice location:
  • Phone: 706-291-4119
  • Fax: 706-291-6866
Mailing address:
  • Phone: 706-291-4119
  • Fax: 706-291-6866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CHUCK LOCKE
Title or Position: VICE PRESIDENT
Credential:
Phone: 615-373-7604