Provider Demographics
NPI:1225630395
Name:MEDICI URGENT CARE AND WELLNESS CENTER
Entity Type:Organization
Organization Name:MEDICI URGENT CARE AND WELLNESS CENTER
Other - Org Name:MEDICI URGENT CARE AND WELLNESS CENTER, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MBOH
Authorized Official - Middle Name:E
Authorized Official - Last Name:ELANGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-778-6983
Mailing Address - Street 1:1039 GRANT ST SE STE D12
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-2014
Mailing Address - Country:US
Mailing Address - Phone:678-778-6983
Mailing Address - Fax:
Practice Address - Street 1:1039 GRANT ST SE STE D12
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-2014
Practice Address - Country:US
Practice Address - Phone:678-736-5248
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-12
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty