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General NPI Number Information
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NPI Number | 1083160436
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Entity Type | Organization
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Legal Business Name | NOAH'S ARK URGENT CARE LLC
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Dates
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Enumeration Date | 08/26/2016
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Last Update Date | 09/17/2016
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Provider Practice Location Address
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Address Line | 950 EAGLES LANDING PKWY SUITE 212
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7343
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Country | US
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Telephone | 470-771-9677
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Fax |
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Provider Business Mailing Address
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Address Line | 950 EAGLES LANDING PKWY SUITE 212
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7343
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Country | US
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Telephone | 470-771-9677
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Fax |
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Authorized Official
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Title or Position | OWNER/MANAGER
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Name | MS. CHARLA VERDENE JOHNSON
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Credential | PA-C
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Telephone | 470-771-9677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 003556
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License Number State | GA
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