Provider Demographics
NPI:1932707650
Name:RELYMD MEDICAL GROUP AR, PLLC
Entity Type:Organization
Organization Name:RELYMD MEDICAL GROUP AR, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CREATORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-932-0928
Mailing Address - Street 1:510 MEADOWMONT VILLAGE CIR STE 323
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-7584
Mailing Address - Country:US
Mailing Address - Phone:919-932-0928
Mailing Address - Fax:
Practice Address - Street 1:1215 TWIN LAKES DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6768
Practice Address - Country:US
Practice Address - Phone:919-932-0928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RELYMD MEDICAL GROUP, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-14
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty