Provider Demographics
NPI:1346488707
Name:AUBURN PRIMARY CARE, PC
Entity Type:Organization
Organization Name:AUBURN PRIMARY CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:SCHLOSSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-822-5555
Mailing Address - Street 1:12 7TH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30011-3202
Mailing Address - Country:US
Mailing Address - Phone:770-822-5555
Mailing Address - Fax:770-822-6117
Practice Address - Street 1:12 7TH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:GA
Practice Address - Zip Code:30011-3202
Practice Address - Country:US
Practice Address - Phone:770-822-5555
Practice Address - Fax:770-822-6117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-23
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA044330261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000825404BMedicaid
GAG95065Medicare PIN