Provider Demographics
NPI:1659431708
Name:AR MEDICAL LLC
Entity Type:Organization
Organization Name:AR MEDICAL LLC
Other - Org Name:SOUTH CARE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FIROZ
Authorized Official - Middle Name:
Authorized Official - Last Name:PATKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-625-7597
Mailing Address - Street 1:809 PEACHTREE ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30434-1449
Mailing Address - Country:US
Mailing Address - Phone:478-625-7597
Mailing Address - Fax:478-625-8364
Practice Address - Street 1:2514-C TABACCO RD
Practice Address - Street 2:
Practice Address - City:HEPHZIBAH
Practice Address - State:GA
Practice Address - Zip Code:30815-7005
Practice Address - Country:US
Practice Address - Phone:706-790-0311
Practice Address - Fax:706-790-0815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA113948Medicare Oscar/Certification