Provider Demographics
NPI:1134422157
Name:IMR IMMEDIATE CARE, LLC
Entity type:Organization
Organization Name:IMR IMMEDIATE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CRANDALL
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-FNP
Authorized Official - Phone:678-957-1043
Mailing Address - Street 1:3540 DULUTH PARK LN
Mailing Address - Street 2:SUITE 260
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-6674
Mailing Address - Country:US
Mailing Address - Phone:678-957-1043
Mailing Address - Fax:678-957-1093
Practice Address - Street 1:3540 DULUTH PARK LN
Practice Address - Street 2:SUITE 260
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-6674
Practice Address - Country:US
Practice Address - Phone:678-957-1043
Practice Address - Fax:678-957-1093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN173213 NP363LF0000X
GAGA042979207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty