Provider Demographics
NPI:1306916119
Name:AR MEDICAL LLC
Entity type:Organization
Organization Name:AR MEDICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:FIROZ
Authorized Official - Middle Name:
Authorized Official - Last Name:PATKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-625-7597
Mailing Address - Street 1:809 PEACHTREE STREET
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30434-1449
Mailing Address - Country:US
Mailing Address - Phone:478-625-7597
Mailing Address - Fax:478-625-8364
Practice Address - Street 1:15 NORTH MCDONALD STREET
Practice Address - Street 2:
Practice Address - City:LUDOWICI
Practice Address - State:GA
Practice Address - Zip Code:31316-0068
Practice Address - Country:US
Practice Address - Phone:912-545-9511
Practice Address - Fax:912-545-9341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055131261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA113962Medicare Oscar/Certification