Provider Demographics
NPI:1457995045
Name:REAGAN URGENT CARE
Entity Type:Organization
Organization Name:REAGAN URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
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:678-344-8700
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:678-344-8700
Mailing Address - Fax:678-344-8600
Practice Address - Street 1:2878 FIVE FORKS TRICKUM RD STE 2A
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044
Practice Address - Country:US
Practice Address - Phone:678-344-8700
Practice Address - Fax:678-344-8600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-06
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care