# REAGAN MEDICAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** REAGAN MEDICAL CENTER
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1003426628
- **Legal business name:** REAGAN MEDICAL CENTER
- **Authorized official:** SATISH B PODDAR (MD)
- **Authorized official phone:** (678) 344-8700

## Contact information

- **Practice address:** 1241 FRIENDSHIP RD STE 110, BRASELTON, GA 30517-5609
- **Practice address phone:** (678) 344-8700
- **Mailing address:** 2878 FIVE FORKS TRICKUM RD STE 2A, LAWRENCEVILLE, GA 30044-5896
- **Mailing address phone:** (678) 344-8700

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207T00000X | Neurological Surgery Physician | — | NULL | — |
| 207T00000X | Neurological Surgery Physician | — | — | — |

## Other

- **Enumeration date:** 08/07/2020
- **Last updated:** 08/07/2020