Organization
SOUTHEAST URGENT CARE LLC
Active
Other names
Southeast Urgent Care
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA FOSTER (CREDENTIALING SPECIALIST)
(815) 713-2600
Entity
Organization
Contact information
Practice address
2118 SCENIC HWY N, SUITE H-I, SNELLVILLE, GA 30078-2633
(770) 558-6017
Mailing address
2118 SCENIC HWY N, SUITE H-I, SNELLVILLE, GA 30078-2633
(770) 558-6017
Taxonomy
Speciality
Code
Description
License number
State
261QU0200X
Urgent Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202G704101
GROUP PTAN
GA
Enumeration date
09/28/2010
Last updated
08/29/2011
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