MEDICARE: REDDY URGENT CARE - ROYSTON LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician
2	261QU0200X	Urgent Care Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	113885	OTHER	GA	MEDICARE PTAN #- RHC

General Provider Information

NPI Number	:	1093847444
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	REDDY URGENT CARE - ROYSTON LLC

Provider Business Mailing Address
First Line	:	1061 DOWDY RD STE 101
Second Line	:
City	:	ATHENS
State	:	GA
Zip	:	30606-5700
Country	:	US
Telephone Number	:	706-621-7575
Fax Number	:	706-621-7557

Provider Business Practice Location Address
First Line	:	132 FRANKLIN SPRINGS ST
Second Line	:
City	:	ROYSTON
State	:	GA
Zip	:	30662-4134
Country	:	US
Telephone Number	:	706-245-7371
Fax Number	:	706-245-9257

Authorized Official
Title or Position	:	CEO
Name	:	RAM REDDY
Credential	:	MD
Telephone Number	:	706-621-7575

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	01/14/2019

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