MEDICARE: BETHANY BEND URGENT CARE, P.C.

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	261QU0200X	Urgent Care Clinic/Center	033707	GA

General Provider Information

NPI Number	:	1669605234
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHANY BEND URGENT CARE, P.C.

Provider Business Mailing Address
First Line	:	13081 HIGHWAY 9 N
Second Line	:
City	:	MILTON
State	:	GA
Zip	:	30004-5150
Country	:	US
Telephone Number	:	770-521-6690
Fax Number	:	770-521-6609

Provider Business Practice Location Address
First Line	:	13081 HIGHWAY 9 N
Second Line	:
City	:	MILTON
State	:	GA
Zip	:	30004-5150
Country	:	US
Telephone Number	:	770-521-6690
Fax Number	:	770-521-6609

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. DAVID J SMITH
Credential	:	D.O.
Telephone Number	:	770-521-6690

Provider Enumeration Date	:	08/31/2009
Last Update Date	:	12/01/2010

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