Provider Demographics
NPI:1457968372
Name:REAGAN MEDICAL CENTER
Entity Type:Organization
Organization Name:REAGAN MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SATISH
Authorized Official - Middle Name:B
Authorized Official - Last Name:PODDAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-344-8700
Mailing Address - Street 1:2878 FIVE FORKS TRICKUM RD STE 2A
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-5896
Mailing Address - Country:US
Mailing Address - Phone:678-999-2299
Mailing Address - Fax:
Practice Address - Street 1:1295 HEMBREE RD STE 200
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-5721
Practice Address - Country:US
Practice Address - Phone:678-344-8700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REAGAN MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty