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General NPI Number Information
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NPI Number | 1316986227
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Entity Type | Organization
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Legal Business Name | CARTERSVILLE URGENT CARE LLC
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 06/04/2008
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Provider Practice Location Address
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Address Line | 824 WEST AVE
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City | CARTERSVILLE
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State | GA
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Zip | 30120-6100
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Country | US
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Telephone | 678-721-5570
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Fax |
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Provider Business Mailing Address
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Address Line | 824 WEST AVE
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City | CARTERSVILLE
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State | GA
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Zip | 30120-6100
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Country | US
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Telephone | 678-721-5570
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Fax |
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Authorized Official
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Title or Position | VP
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Name | JEFF RYDBURG
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Credential |
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Telephone | 615-373-7600
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State | GA
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