Provider Demographics
NPI:1790332831
Name:GRANLAND3 LLC
Entity Type:Organization
Organization Name:GRANLAND3 LLC
Other - Org Name:ALBANY URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PARRISH
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:229-496-2472
Mailing Address - Street 1:158 WINSHIP DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-5319
Mailing Address - Country:US
Mailing Address - Phone:229-496-2472
Mailing Address - Fax:229-496-2473
Practice Address - Street 1:2622 DAWSON RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-1609
Practice Address - Country:US
Practice Address - Phone:229-395-1264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GRANLAND3 LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-22
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty