Healthcare Provider Details

I. General information

NPI: 1356330583
Provider Name (Legal Business Name): REDMOND PHYSICIAN PRACTICE COMPANY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5865 NEW CALHOUN HIGHWAY, N.E.
SHANNON GA
30172
US

IV. Provider business mailing address

5865 NEW CALHOUN HIGHWAY, N.E.
SHANNON GA
30172
US

V. Phone/Fax

Practice location:
  • Phone: 706-236-1919
  • Fax: 706-236-1919
Mailing address:
  • Phone: 706-236-1919
  • Fax: 706-236-1919

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: DIRECTOR
Credential:
Phone: 615-373-7604