Provider Demographics
NPI:1497313258
Name:PHYSICIANS UNITED URGENT CARE, P.C.
Entity Type:Organization
Organization Name:PHYSICIANS UNITED URGENT CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FATIMA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:KASIAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:470-819-4849
Mailing Address - Street 1:3915 CASCADE RD SW STE T-150
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8512
Mailing Address - Country:US
Mailing Address - Phone:470-819-4849
Mailing Address - Fax:
Practice Address - Street 1:253 ROBT DANEL JR PKWY STE C
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-0805
Practice Address - Country:US
Practice Address - Phone:470-819-4849
Practice Address - Fax:470-819-4887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-05
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1639480684Medicaid