Provider Demographics
NPI:1790031664
Name:NR MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:NR MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EL SHAFEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-744-2168
Mailing Address - Street 1:213 ARROWHEAD BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-1168
Mailing Address - Country:US
Mailing Address - Phone:770-703-8074
Mailing Address - Fax:
Practice Address - Street 1:213 ARROWHEAD BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-1168
Practice Address - Country:US
Practice Address - Phone:770-703-8074
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA61081261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain