Provider Demographics
NPI:1164940672
Name:PRIMECARE MEDICAL CENTER
Entity Type:Organization
Organization Name:PRIMECARE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRIDGETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-755-5334
Mailing Address - Street 1:86 UPPER RIVERDALE RD SW STE 201
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30274-2614
Mailing Address - Country:US
Mailing Address - Phone:770-907-4219
Mailing Address - Fax:
Practice Address - Street 1:86 UPPER RIVERDALE RD SW STE 201
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:GA
Practice Address - Zip Code:30274-2614
Practice Address - Country:US
Practice Address - Phone:770-907-4219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center