Provider Demographics
NPI:1114591096
Name:PRIME CARE OF GEORGIA LLC
Entity Type:Organization
Organization Name:PRIME CARE OF GEORGIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHITAL
Authorized Official - Middle Name:G
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-561-7001
Mailing Address - Street 1:1000 TOWNE CENTER BLVD STE 604
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-4070
Mailing Address - Country:US
Mailing Address - Phone:912-561-7001
Mailing Address - Fax:912-561-7002
Practice Address - Street 1:1000 TOWNE CENTER BLVD STE 604
Practice Address - Street 2:
Practice Address - City:POOLER
Practice Address - State:GA
Practice Address - Zip Code:31322-4070
Practice Address - Country:US
Practice Address - Phone:912-561-7001
Practice Address - Fax:912-561-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-17
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty