Provider Demographics
NPI:1689097859
Name:REDDY URGENT CARE-MONROE LLC
Entity Type:Organization
Organization Name:REDDY URGENT CARE-MONROE LLC
Other - Org Name:MONROE REDDY URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:M
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-621-7561
Mailing Address - Street 1:PO BOX 529
Mailing Address - Street 2:
Mailing Address - City:ROYSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30662-0529
Mailing Address - Country:US
Mailing Address - Phone:706-621-7575
Mailing Address - Fax:706-621-7557
Practice Address - Street 1:500 GREAT OAKS DR
Practice Address - Street 2:SUITE 9
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-8225
Practice Address - Country:US
Practice Address - Phone:706-621-7575
Practice Address - Fax:706-621-7557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-24
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Multi-Specialty