Provider Demographics
NPI:1467645721
Name:IMMEDIATE MEDCARE OF ELLIJAY, LLC
Entity Type:Organization
Organization Name:IMMEDIATE MEDCARE OF ELLIJAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-467-4440
Mailing Address - Street 1:PO BOX 306
Mailing Address - Street 2:
Mailing Address - City:EAST ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30539-0006
Mailing Address - Country:US
Mailing Address - Phone:706-635-6325
Mailing Address - Fax:706-635-6326
Practice Address - Street 1:526 MADDOX DR STE 101
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-5566
Practice Address - Country:US
Practice Address - Phone:706-635-6325
Practice Address - Fax:706-635-6326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care