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General NPI Number Information
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NPI Number | 1831809409
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Entity Type | Organization
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Legal Business Name | MED-2-GO URGENT CARE
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Dates
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Enumeration Date | 12/05/2022
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 3904 WELHAM GREEN CT
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-7236
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Country | US
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Telephone | 808-225-1682
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Fax |
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Provider Business Mailing Address
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Address Line | 3904 WELHAM GREEN CT
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City | DOUGLASVILLE
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State | GA
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Zip | 30135-7236
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Country | US
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Telephone | 808-225-1682
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Fax |
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Authorized Official
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Title or Position | PRACTITIONER
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Name | PROF. CASSAUNDRA BURKS
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Credential |
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Telephone | 808-225-1682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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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 | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 246W00000X
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Taxonomy Name | Cardiology Technician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251C00000X
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Taxonomy Name | Developmentally Disabled Services Day Training Agency
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 3747A0650X
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Taxonomy Name | Attendant Care Provider
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #11
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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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