Provider Demographics
NPI:1528407608
Name:PRIKARE PC
Entity Type:Organization
Organization Name:PRIKARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:WILLOUGHBY
Authorized Official - Last Name:FOGARTY
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:770-539-9600
Mailing Address - Street 1:2350 LIMESTONE PKWY
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-2013
Mailing Address - Country:US
Mailing Address - Phone:770-539-9600
Mailing Address - Fax:770-539-9605
Practice Address - Street 1:2350 LIMESTONE PKWY
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-2013
Practice Address - Country:US
Practice Address - Phone:770-539-9600
Practice Address - Fax:770-539-9605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA041118207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty