Provider Demographics
NPI:1508340860
Name:COMPASS PRIMARY CARE LLC
Entity Type:Organization
Organization Name:COMPASS PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:470-369-7800
Mailing Address - Street 1:1720 PHOENIX BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30349-5596
Mailing Address - Country:US
Mailing Address - Phone:470-369-7800
Mailing Address - Fax:470-369-7801
Practice Address - Street 1:1720 PHOENIX BLVD STE 700
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:GA
Practice Address - Zip Code:30349-5596
Practice Address - Country:US
Practice Address - Phone:470-369-7800
Practice Address - Fax:470-369-7801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty