Provider Demographics
NPI:1952591646
Name:US MEDICAL CORPORATION LLC
Entity type:Organization
Organization Name:US MEDICAL CORPORATION LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FAREHA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-335-9411
Mailing Address - Street 1:613 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-1143
Mailing Address - Country:US
Mailing Address - Phone:706-335-9411
Mailing Address - Fax:706-335-1911
Practice Address - Street 1:613 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-1143
Practice Address - Country:US
Practice Address - Phone:706-335-9411
Practice Address - Fax:706-335-1911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047505207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAH33784OtherBLUE CROSS OF GA
GA000897685AMedicaid
GA047505OtherLICENSE NUMBER
GABR7086514OtherDEA
GA000897685AMedicaid
GA=========OtherTRICARE
GABR7086514OtherDEA