Provider Demographics
NPI:1508006503
Name:ATLANTA URGENT CARE CLINIC
Entity Type:Organization
Organization Name:ATLANTA URGENT CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NARENDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-495-0011
Mailing Address - Street 1:10160 MEDLOCK BRIDGE RD
Mailing Address - Street 2:STE 200
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-4419
Mailing Address - Country:US
Mailing Address - Phone:770-495-0011
Mailing Address - Fax:
Practice Address - Street 1:10160 MEDLOCK BRIDGE RD
Practice Address - Street 2:STE 200
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30097-4419
Practice Address - Country:US
Practice Address - Phone:770-495-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA51657261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA161378374CMedicaid
GA11SCDNWOtherMEDICARE DOCTORS NUMBER
GAF65282Medicare UPIN