Provider Demographics
NPI:1063878106
Name:MEDICAL-CARE LLC
Entity type:Organization
Organization Name:MEDICAL-CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAHIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:478-625-7597
Mailing Address - Street 1:809 PEACHTREE ST
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:
Practice Address - Street 1:809 PEACHTREE ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:GA
Practice Address - Zip Code:30434-1449
Practice Address - Country:US
Practice Address - Phone:478-625-7597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-05
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11-3965261QR1300X
GA11-3948261QR1300X
GA11-3954261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1346239639OtherNPI
GA679204194AMedicaid
GA1659431708OtherNPI
GA415880091AMedicaid
GA1821079138OtherNPI
GA191448438AMedicaid
GA1962562884OtherNPI
GA616207670DMedicaid
GA000505568DMedicaid
GA1164472478OtherNPI