Provider Demographics
NPI:1215600564
Name:MEDPLUS IMMEDIATE CARE
Entity Type:Organization
Organization Name:MEDPLUS IMMEDIATE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-219-9514
Mailing Address - Street 1:1101 HILLCREST PKWY STE L
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-3581
Mailing Address - Country:US
Mailing Address - Phone:478-272-8140
Mailing Address - Fax:478-277-0276
Practice Address - Street 1:5585 THOMASTON RD STE A600
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31220-8200
Practice Address - Country:US
Practice Address - Phone:478-219-9514
Practice Address - Fax:478-259-2836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-30
Last Update Date:2021-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty