Healthcare Provider Details

I. General information

NPI: 1952316747
Provider Name (Legal Business Name): REAGAN MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 04/05/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2696 LAWRENCEVILLE SUWANEE RD
SUWANEE GA
30024-2535
US

IV. Provider business mailing address

2878 FIVE FORKS TRICKUM RD STE 2A
LAWRENCEVILLE GA
30044-5896
US

V. Phone/Fax

Practice location:
  • Phone: 678-344-8700
  • Fax:
Mailing address:
  • Phone: 678-344-8700
  • Fax: 678-344-8600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MR. SATISH PODDAR
Title or Position: CEO
Credential: MD
Phone: 678-344-8700