Provider Demographics
NPI:1821346073
Name:REDDY URGENT CARE-HARTWELL LLC
Entity Type:Organization
Organization Name:REDDY URGENT CARE-HARTWELL LLC
Other - Org Name:REDDY URGENT CARE-HARTWELL LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAM
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-621-7575
Mailing Address - Street 1:1061 DOWDY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-5700
Mailing Address - Country:US
Mailing Address - Phone:706-621-7575
Mailing Address - Fax:706-621-7557
Practice Address - Street 1:605 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:HARTWELL
Practice Address - State:GA
Practice Address - Zip Code:30643-7301
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:2012-08-20
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA24178207R00000X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA118909OtherMEDICARE PTAN - RHC
GAGRP3137OtherMEDICARE GROUP ID