Provider Demographics
NPI:1205405982
Name:PRESTIGEHEALTH PRIMARY AND URGENT CARE LLC
Entity Type:Organization
Organization Name:PRESTIGEHEALTH PRIMARY AND URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ADEGBOYEGA
Authorized Official - Middle Name:OYEGBENGA
Authorized Official - Last Name:ORELAJA
Authorized Official - Suffix:
Authorized Official - Credentials:PHYSICIAN ASSISTANT
Authorized Official - Phone:678-387-2710
Mailing Address - Street 1:3920 JONESBORO RD STE 3
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-2258
Mailing Address - Country:US
Mailing Address - Phone:678-387-2710
Mailing Address - Fax:
Practice Address - Street 1:3920 JONESBORO RD STE 3
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-2258
Practice Address - Country:US
Practice Address - Phone:678-387-2710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-17
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty