Provider Demographics
NPI:1346858255
Name:CASTELLUM MEDICAL CONSULTANTS LLC
Entity Type:Organization
Organization Name:CASTELLUM MEDICAL CONSULTANTS LLC
Other - Org Name:PRIMETIME URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:N
Authorized Official - Last Name:PRICE
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:770-284-5374
Mailing Address - Street 1:1618 MARS HILL RD STE A
Mailing Address - Street 2:BOX A9
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-4847
Mailing Address - Country:US
Mailing Address - Phone:706-705-4543
Mailing Address - Fax:
Practice Address - Street 1:1618 MARS HILL RD STE A
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-4847
Practice Address - Country:US
Practice Address - Phone:706-705-4543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-16
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty