Provider Demographics
NPI:1235467507
Name:RENTZ HEALTH CARE
Entity Type:Organization
Organization Name:RENTZ HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JIMMY
Authorized Official - Middle Name:H
Authorized Official - Last Name:MADDOX
Authorized Official - Suffix:JR
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:478-984-1102
Mailing Address - Street 1:2160 HIGHWAY 117
Mailing Address - Street 2:
Mailing Address - City:RENTZ
Mailing Address - State:GA
Mailing Address - Zip Code:31075
Mailing Address - Country:US
Mailing Address - Phone:478-984-1102
Mailing Address - Fax:478-984-1103
Practice Address - Street 1:2160 HIGHWAY 117
Practice Address - Street 2:
Practice Address - City:RENTZ
Practice Address - State:GA
Practice Address - Zip Code:31075
Practice Address - Country:US
Practice Address - Phone:478-984-1102
Practice Address - Fax:478-984-1103
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-25
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN166580261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care