Provider Demographics
NPI:1386802155
Name:URGENT CARE BANKS CROSSING LLC
Entity type:Organization
Organization Name:URGENT CARE BANKS CROSSING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BROOKSHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-336-0074
Mailing Address - Street 1:P.O. BOX 1055
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529
Mailing Address - Country:US
Mailing Address - Phone:706-336-0074
Mailing Address - Fax:706-336-0079
Practice Address - Street 1:415 B POTTERY FACTORY DRIVE
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529
Practice Address - Country:US
Practice Address - Phone:706-336-0074
Practice Address - Fax:706-336-0079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-29
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA049138207L00000X, 208600000X, 208VP0000X
GA208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA971545216BMedicaid
GA1497763254OtherNPI
GA000771999HMedicaid
GA1033127899OtherNPI
GA1497763254OtherNPI
GA1033127899OtherNPI
GA02BBGNJMedicare PIN