Provider Demographics
NPI:1467771832
Name:REAGAN MEDICAL CENTER
Entity Type:Organization
Organization Name:REAGAN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SATISH
Authorized Official - Middle Name:
Authorized Official - Last Name:PODDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-344-8700
Mailing Address - Street 1:2878 FIVE FORKS TRICKUM RD
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-5896
Mailing Address - Country:US
Mailing Address - Phone:678-344-8700
Mailing Address - Fax:678-344-8600
Practice Address - Street 1:10160 MEDLOCK BRIDGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-4419
Practice Address - Country:US
Practice Address - Phone:678-344-8700
Practice Address - Fax:678-344-8600
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REAGAN MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-05-25
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty