Provider Demographics
NPI:1649365750
Name:REAGAN MEDICAL CENTER
Entity type:Organization
Organization Name:REAGAN MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:BARTLETT
Authorized Official - Last Name:HERRIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-654-3665
Mailing Address - Street 1:2696 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-2535
Mailing Address - Country:US
Mailing Address - Phone:770-771-5570
Mailing Address - Fax:770-771-5571
Practice Address - Street 1:2696 LAWRENCEVILLE SUWANEE RD
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-2535
Practice Address - Country:US
Practice Address - Phone:770-771-5570
Practice Address - Fax:770-771-5571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048008207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1861412629OtherNPI