Healthcare Provider Details

I. General information

NPI: 1780838847
Provider Name (Legal Business Name): GEORGETOWN URGENT CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2008
Last Update Date: 05/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 OSBOURNE WAY SUITE 101
GEORGETOWN KY
40324-8004
US

IV. Provider business mailing address

111 OSBOURNE WAY SUITE 101
GEORGETOWN KY
40324-8004
US

V. Phone/Fax

Practice location:
  • Phone: 859-466-8956
  • Fax:
Mailing address:
  • Phone: 502-570-0007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NAWAR SODA
Title or Position: OWNER
Credential: MD
Phone: 859-466-8956