Healthcare Provider Details

I. General information

NPI: 1164472338
Provider Name (Legal Business Name): AR MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MCDONALD ST
LUDOWICI GA
31316-4500
US

IV. Provider business mailing address

809 PEACHTREE ST
LOUISVILLE GA
30434-1449
US

V. Phone/Fax

Practice location:
  • Phone: 912-545-9511
  • Fax: 912-545-9341
Mailing address:
  • Phone: 478-625-7597
  • Fax: 478-625-8364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number055131
License Number StateGA

VIII. Authorized Official

Name: DR. FIROZ PATKA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 478-625-7597