Medica at Rabun, LLC

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

License

NONE Issued in GA

Legal business name

MEDICA AT RABUN, LLC

Practice address

7499 Old Highway 441 South
Lakemont, GA 30552

Phone

(706) 782-0770

Fax

(706) 782-1091

NPI assigned

Jun 15, 2006

Organization subpart

No

Name

Mary Kay Baker

Title

VP of Operations

Phone

(678) 354-6766

• Medica at Rabun Open MRI Doing business as

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1720022411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7499 OLD HIGHWAY 441 SOUTH",
            "city": "LAKEMONT",
            "state": "GA",
            "postal_code": "30552",
            "telephone_number": "706-782-0770",
            "fax_number": "706-782-1091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7499 OLD HIGHWAY 441 SOUTH",
            "city": "LAKEMONT",
            "state": "GA",
            "postal_code": "30552",
            "telephone_number": "706-782-0770",
            "fax_number": "706-782-1091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICA AT RABUN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "678-354-6766"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "GA",
            "license": "NONE",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medica at Rabun Open MRI",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Arthur Bartholomew Flick, MD
• Suzanne Newkirk, RDH
• WM C Sharpton Jr., OD
• Ena Weinstein, ATC
• Susan Colpitts Wuttke, LCSW

• All providers in Lakemont, GA
• Radiology Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.