Provider Demographics
NPI:1083727580
Name:PERRY PRIMARY CARE
Entity Type:Organization
Organization Name:PERRY PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARUNAKER
Authorized Official - Middle Name:R
Authorized Official - Last Name:SRIPATHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:478-987-2578
Mailing Address - Street 1:209 WES PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:GA
Mailing Address - Zip Code:31069-2948
Mailing Address - Country:US
Mailing Address - Phone:478-987-2578
Mailing Address - Fax:478-987-2598
Practice Address - Street 1:209 WES PARK DRIVE
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:GA
Practice Address - Zip Code:31069-2948
Practice Address - Country:US
Practice Address - Phone:478-987-2578
Practice Address - Fax:478-987-2598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044110207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000771251DMedicaid
GA000771251DMedicaid
GAG60444Medicare UPIN