Organization
URGENT CARE BANKS CROSSING LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA A BROOKSHIRE (OFFICE MANAGER)
(706) 336-0074
Entity
Organization
Contact information
Practice address
415 B POTTERY FACTORY DR, COMMERCE, GA 30529-6682
(706) 336-0074
(706) 336-0079
Mailing address
PO BOX 1055, 415 B POTTERY FACTORY DR, COMMERCE, GA 30529-0020
(706) 336-0074
(706) 336-0079
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
049138
GA
261QP2300X
Primary Care Clinic/Center
Primary
049138
GA
261QU0200X
Urgent Care Clinic/Center
049138
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
134759118
MEDICAID REFERENCE NUMBER
GA
01
—
1386802155
NPI 1386802155
GA
05
—
971545216B
—
GA
Enumeration date
06/30/2009
Last updated
08/03/2010
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