Provider Demographics
NPI:1477800720
Name:CENTER FOR PRIMARY CARE PC
Entity Type:Organization
Organization Name:CENTER FOR PRIMARY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:F
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-922-8294
Mailing Address - Street 1:PO BOX 1967
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809
Mailing Address - Country:US
Mailing Address - Phone:706-922-8294
Mailing Address - Fax:706-650-9540
Practice Address - Street 1:105 E HUGH ST
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-2925
Practice Address - Country:US
Practice Address - Phone:803-279-6800
Practice Address - Fax:803-279-2876
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR PRIMARY CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-06
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7979Medicare UPIN