Provider Demographics
NPI:1306000906
Name:PREMIER FAMILY MEDICINE CENTER, LLC
Entity Type:Organization
Organization Name:PREMIER FAMILY MEDICINE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:P
Authorized Official - Last Name:EUBANKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-296-5114
Mailing Address - Street 1:484 IRVIN CT STE 110
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-5406
Mailing Address - Country:US
Mailing Address - Phone:404-296-5114
Mailing Address - Fax:404-296-5115
Practice Address - Street 1:484 IRVIN CT
Practice Address - Street 2:SUITE 110
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-5406
Practice Address - Country:US
Practice Address - Phone:404-296-5114
Practice Address - Fax:404-296-5115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-12
Last Update Date:2008-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty