Healthcare Provider Details

I. General information

NPI: 1093847444
Provider Name (Legal Business Name): REDDY URGENT CARE - ROYSTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 FRANKLIN SPRINGS ST
ROYSTON GA
30662-4134
US

IV. Provider business mailing address

1061 DOWDY RD STE 101
ATHENS GA
30606-5700
US

V. Phone/Fax

Practice location:
  • Phone: 706-245-7371
  • Fax: 706-245-9257
Mailing address:
  • Phone: 706-621-7575
  • Fax: 706-621-7557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: RAM REDDY
Title or Position: CEO
Credential: MD
Phone: 706-621-7575