Provider Demographics
NPI:1326758525
Name:AFFINITY PRIMARY CARE LLC
Entity Type:Organization
Organization Name:AFFINITY PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PRASANNA
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:ALLADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-701-1435
Mailing Address - Street 1:2120 SPRINGHOUSE RD SE
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35802-1869
Mailing Address - Country:US
Mailing Address - Phone:256-701-1435
Mailing Address - Fax:
Practice Address - Street 1:1010 AIRPORT RD SW STE C
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1478
Practice Address - Country:US
Practice Address - Phone:256-824-9966
Practice Address - Fax:256-242-1022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty