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General NPI Number Information
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NPI Number | 1134396039
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Entity Type | Organization
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Legal Business Name | IDEAL URGENT CARE, PC
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Dates
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Enumeration Date | 05/11/2008
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Last Update Date | 05/11/2008
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Provider Practice Location Address
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Address Line | 3523 BUFORD HWY NE SUITE 100B
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City | ATLANTA
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State | GA
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Zip | 30329-1278
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Country | US
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Telephone | 770-315-6797
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1644
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City | MABLETON
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State | GA
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Zip | 30126-1010
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GEORGE TUCKER
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Credential | MD
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Telephone | 770-315-6797
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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 | 022068
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License Number State | GA
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