Provider Demographics
NPI:1972666253
Name:REAGAN MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:REAGAN MEDICAL CENTER LLC
Other - Org Name:HAMILTON MILL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SATISH
Authorized Official - Middle Name:
Authorized Official - Last Name:PODDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-546-9800
Mailing Address - Street 1:3685 BRASELTON HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-5920
Mailing Address - Country:US
Mailing Address - Phone:678-546-9800
Mailing Address - Fax:678-344-8700
Practice Address - Street 1:3685 BRASELTON HWY
Practice Address - Street 2:100
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-5920
Practice Address - Country:US
Practice Address - Phone:678-546-9800
Practice Address - Fax:678-344-8600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherTX ID