Provider Demographics
NPI:1194396846
Name:PRYME COMMUNITY CLINIC INCORPORATED
Entity Type:Organization
Organization Name:PRYME COMMUNITY CLINIC INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, CRNP FAMILY
Authorized Official - Phone:240-413-0052
Mailing Address - Street 1:6201 GREENBELT RD STE M8A
Mailing Address - Street 2:
Mailing Address - City:BERWYN HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20740-2358
Mailing Address - Country:US
Mailing Address - Phone:240-413-0052
Mailing Address - Fax:301-358-2940
Practice Address - Street 1:6201 GREENBELT RD STE M8A
Practice Address - Street 2:
Practice Address - City:BERWYN HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20740-2358
Practice Address - Country:US
Practice Address - Phone:240-413-0052
Practice Address - Fax:301-358-2940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-05
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty