Provider Demographics
NPI:1174790331
Name:ROSWELL URGENT CARE CENTER LLC
Entity type:Organization
Organization Name:ROSWELL URGENT CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:DENNIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-317-2696
Mailing Address - Street 1:660 W CROSSVILLE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-7525
Mailing Address - Country:US
Mailing Address - Phone:770-992-4700
Mailing Address - Fax:
Practice Address - Street 1:660 W CROSSVILLE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-7525
Practice Address - Country:US
Practice Address - Phone:770-992-4700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511G700784Medicare PIN
GA6253790001Medicare NSC