Provider Demographics
NPI:1528375904
Name:PRIMECARE PHYSICIANS OF JACKSONVILLE, PLLC
Entity Type:Organization
Organization Name:PRIMECARE PHYSICIANS OF JACKSONVILLE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:910-353-3000
Mailing Address - Street 1:29 OFFICE PARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-3219
Mailing Address - Country:US
Mailing Address - Phone:910-353-3000
Mailing Address - Fax:910-238-4456
Practice Address - Street 1:29 OFFICE PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546-3219
Practice Address - Country:US
Practice Address - Phone:910-353-3000
Practice Address - Fax:910-238-4456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC168380207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty