Provider Demographics
NPI:1417397662
Name:RIESA JOHN GREATER ATLANTA URGENT CARE
Entity Type:Organization
Organization Name:RIESA JOHN GREATER ATLANTA URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:
Authorized Official - Last Name:AMUKAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:706-253-3341
Mailing Address - Street 1:91 SAMMY MCGHEE BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-7703
Mailing Address - Country:US
Mailing Address - Phone:706-253-3341
Mailing Address - Fax:706-253-3361
Practice Address - Street 1:91 SAMMY MCGHEE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-7703
Practice Address - Country:US
Practice Address - Phone:706-253-3341
Practice Address - Fax:706-253-3361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-02
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA29173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty