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General NPI Number Information
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NPI Number | 1306241336
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Entity Type | Organization
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Legal Business Name | URGENT CARE CENTER OF CENTRAL GEORGIA LLC
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Dates
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Enumeration Date | 11/04/2014
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Last Update Date | 06/30/2017
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Provider Practice Location Address
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Address Line | 113 WILLIE LEE PKWY
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City | WARNER ROBINS
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State | GA
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Zip | 31088-8970
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Country | US
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Telephone | 478-333-6688
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Fax |
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Provider Business Mailing Address
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Address Line | 1030 CHEROKEE RD
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City | PERRY
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State | GA
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Zip | 31069-2243
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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 | OWNER/PHYSICIAN
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Name | DR. JONATHAN VELASQUEZ
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Credential |
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Telephone | 478-997-9237
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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 |
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License Number State |
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