Provider Demographics
NPI:1629606454
Name:ADVANCED PRIMARY CARE
Entity Type:Organization
Organization Name:ADVANCED PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLA
Authorized Official - Middle Name:ANTOINETTE
Authorized Official - Last Name:PATTON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:301-970-9677
Mailing Address - Street 1:6125 ROSWELL RD UNIT 583
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3942
Mailing Address - Country:US
Mailing Address - Phone:301-970-9677
Mailing Address - Fax:
Practice Address - Street 1:525 EASTERN AVE # B2
Practice Address - Street 2:
Practice Address - City:FAIRMOUNT HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20743-1677
Practice Address - Country:US
Practice Address - Phone:301-970-9677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-28
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care