Provider Demographics
NPI:1811422439
Name:KWIK KARE OF GEORGIA, INC.
Entity Type:Organization
Organization Name:KWIK KARE OF GEORGIA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:KOZUSNIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-573-0167
Mailing Address - Street 1:2511 HIGHWAY 34 E
Mailing Address - Street 2:SUITE C
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2309
Mailing Address - Country:US
Mailing Address - Phone:770-573-0167
Mailing Address - Fax:678-809-2923
Practice Address - Street 1:2511 HIGHWAY 34 E
Practice Address - Street 2:SUITE C
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2309
Practice Address - Country:US
Practice Address - Phone:770-573-0167
Practice Address - Fax:678-809-2923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care