Provider Demographics
NPI:1528559895
Name:GREATER GA PRIMARY & URGENT CARE LLC
Entity Type:Organization
Organization Name:GREATER GA PRIMARY & URGENT CARE LLC
Other - Org Name:GGPUC LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:
Authorized Official - Last Name:AKINOLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-332-5378
Mailing Address - Street 1:406 CENTRAL DR
Mailing Address - Street 2:
Mailing Address - City:EAST DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31027-7412
Mailing Address - Country:US
Mailing Address - Phone:478-304-1412
Mailing Address - Fax:478-304-1472
Practice Address - Street 1:406 CENTRAL DR
Practice Address - Street 2:
Practice Address - City:EAST DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31027-7412
Practice Address - Country:US
Practice Address - Phone:478-304-1412
Practice Address - Fax:478-304-1472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty