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General NPI Number Information
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NPI Number | 1023368693
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICINE AND URGENT CARE, P.C.
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Dates
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Enumeration Date | 09/11/2012
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Last Update Date | 09/13/2012
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Provider Practice Location Address
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Address Line | 4415 FRONT NINE DRIVE, SUITE 700
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City | CUMMING
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State | GA
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Zip | 30041-6018
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Country | US
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Telephone | 678-666-4430
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Fax | 678-666-4422
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Provider Business Mailing Address
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Address Line | 4415 FRONT NINE DRIVE, SUITE 700
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City | CUMMING
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State | GA
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Zip | 30041-6018
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Country | US
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Telephone | 678-666-4430
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Fax | 678-666-4422
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BHASKAR REDDY
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Credential | M.D
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Telephone | 678-666-4430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 055641
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License Number State | GA
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