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NPI Code Detail

MEDICARE: REAGAN MEDICAL CENTER

MEDICARE: REAGAN MEDICAL CENTER
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
1207Q00000XFamily Medicine Physician048008GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11861412629OTHERNPI

General Provider Information

NPI Number : 1649365750
Entity Type Code : Organization
Provider Name (Legal Business Name) : REAGAN MEDICAL CENTER
Provider Business Mailing Address
First Line : 2696 LAWRENCEVILLE SUWANEE RD
Second Line :
City : SUWANEE
State : GA
Zip : 30024-2535
Country : US
Telephone Number : 770-771-5570
Fax Number : 770-771-5571
Provider Business Practice Location Address
First Line : 2696 LAWRENCEVILLE SUWANEE RD
Second Line :
City : SUWANEE
State : GA
Zip : 30024-2535
Country : US
Telephone Number : 770-771-5570
Fax Number : 770-771-5571
Authorized Official
Title or Position : PHYSICIAN
Name : DR. SEAN BARTLETT HERRIN
Credential : M.D.
Telephone Number : 678-654-3665
Provider Enumeration Date : 10/04/2006
Last Update Date : 07/21/2022

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Practice Fax:
1174779177 — MR. ANTHONY E. MEDINA
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Directions to “REAGAN MEDICAL CENTER ” Practice Location

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