Provider Demographics
NPI:1417011099
Name:PACIFIC MEDICAL LLC
Entity Type:Organization
Organization Name:PACIFIC MEDICAL LLC
Other - Org Name:DUNWOODY URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER,PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:N
Authorized Official - Last Name:LOCARNINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-353-2001
Mailing Address - Street 1:1730 MOUNT VERNON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30338-4245
Mailing Address - Country:US
Mailing Address - Phone:770-353-2001
Mailing Address - Fax:770-353-2010
Practice Address - Street 1:1730 MOUNT VERNON RD
Practice Address - Street 2:SUITE B
Practice Address - City:DUNWOODY
Practice Address - State:GA
Practice Address - Zip Code:30338-4245
Practice Address - Country:US
Practice Address - Phone:770-353-2001
Practice Address - Fax:770-353-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA050724261QE0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7518OtherGRP#
GAH63328Medicare UPIN
GA93BFBRRMedicare PIN
GA5813510001Medicare NSC