Imr Immediate Care, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

GA042979 Issued in GA

Legal business name

IMR IMMEDIATE CARE, LLC

Practice address

3540 Duluth Park LN
Suite 260
Duluth, GA 30096-6674

Phone

(678) 957-1043

Fax

(678) 957-1093

NPI assigned

Dec 14, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Lisa Marie Crandall, APRN-FNP

Title

Managing Partner

Phone

(678) 957-1043

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1292284800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292284800000",
    "number": "1134422157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3540 DULUTH PARK LN",
            "address_2": "SUITE 260",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300966674",
            "telephone_number": "678-957-1043",
            "fax_number": "678-957-1093"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3540 DULUTH PARK LN",
            "address_2": "SUITE 260",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300966674",
            "telephone_number": "678-957-1043",
            "fax_number": "678-957-1093"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IMR IMMEDIATE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-14",
        "last_updated": "2010-12-14",
        "status": "A",
        "authorized_official_last_name": "CRANDALL",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "678-957-1043",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "APRN-FNP"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "GA042979",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN173213 NP",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.