Provider Demographics
NPI:1831338136
Name:MILL CREEK URGENT CARE
Entity type:Organization
Organization Name:MILL CREEK URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:B
Authorized Official - Last Name:VICKERY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-704-4911
Mailing Address - Street 1:7820 HICKORY FLAT HWY
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-2099
Mailing Address - Country:US
Mailing Address - Phone:770-704-4911
Mailing Address - Fax:770-704-4922
Practice Address - Street 1:7820 HICKORY FLAT HWY
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-2099
Practice Address - Country:US
Practice Address - Phone:770-704-4911
Practice Address - Fax:770-704-4922
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MILL CREEK FAMILY & URGENT CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty