Provider Demographics
NPI:1356012074
Name:PRIORITYHEALTHCARELLC
Entity Type:Organization
Organization Name:PRIORITYHEALTHCARELLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONNETT
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUMBIE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:470-650-4322
Mailing Address - Street 1:232 BIRCHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-3098
Mailing Address - Country:US
Mailing Address - Phone:678-474-6842
Mailing Address - Fax:
Practice Address - Street 1:1840 OLD NORCROSS RD STE 200
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-8803
Practice Address - Country:US
Practice Address - Phone:470-650-4322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-22
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care