Healthcare Provider Details

I. General information

NPI: 1508915919
Provider Name (Legal Business Name): BRIGHTPOINT URGENT CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 EAGLES LANDING PKWY SUITE 150
STOCKBRIDGE GA
30281-5011
US

IV. Provider business mailing address

913 EAGLES LANDING PKWY SUITE 150
STOCKBRIDGE GA
30281-5011
US

V. Phone/Fax

Practice location:
  • Phone: 770-692-5910
  • Fax: 770-692-5916
Mailing address:
  • Phone: 770-692-5910
  • Fax: 770-692-5916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number035913
License Number StateGA

VIII. Authorized Official

Name: CARLA D JACKSON
Title or Position: VICE PRESIDENT
Credential: LPC
Phone: 770-692-5910