Provider Demographics
NPI:1053662296
Name:COMMUNITY PRIMARY CARE OF GEORGIA LLC
Entity Type:Organization
Organization Name:COMMUNITY PRIMARY CARE OF GEORGIA LLC
Other - Org Name:COMMUNITY PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-401-0225
Mailing Address - Street 1:4080 MCGINNIS FERRY RD
Mailing Address - Street 2:SUITE 804
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3948
Mailing Address - Country:US
Mailing Address - Phone:404-401-0225
Mailing Address - Fax:
Practice Address - Street 1:946 VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30204-3771
Practice Address - Country:US
Practice Address - Phone:770-358-2485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-27
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty