Provider Demographics
NPI:1598794166
Name:PRIMECARE CENTER, LLC
Entity Type:Organization
Organization Name:PRIMECARE CENTER, LLC
Other - Org Name:PRIMACARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:ZUPPA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-270-9989
Mailing Address - Street 1:102 N OAKS DR
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-8392
Mailing Address - Country:US
Mailing Address - Phone:706-270-9989
Mailing Address - Fax:706-259-9601
Practice Address - Street 1:102 N OAKS DR
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-8392
Practice Address - Country:US
Practice Address - Phone:706-270-9989
Practice Address - Fax:706-259-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52526190OtherBCBS GA
GA52526190OtherBCBS GA
GA08BBVDGMedicare PIN