Provider Demographics
NPI:1861452492
Name:PRIMARY MEDICAL CARE
Entity Type:Organization
Organization Name:PRIMARY MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOUELINA
Authorized Official - Middle Name:M
Authorized Official - Last Name:SOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-471-9990
Mailing Address - Street 1:1287 HWY 138 SPUR
Mailing Address - Street 2:SUITE #8
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236
Mailing Address - Country:US
Mailing Address - Phone:770-471-9990
Mailing Address - Fax:770-471-4290
Practice Address - Street 1:1287 HWY 138 SPUR
Practice Address - Street 2:SUITE #8
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236
Practice Address - Country:US
Practice Address - Phone:770-471-9990
Practice Address - Fax:770-471-4290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAO21592207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA010052858Medicaid
85001388GOtherGEORGIA BETTER HEALTH
DA2480OtherRAILROAD MEDICARE
279682172OtherTRICARE
GA000368046DMedicaid
P00039443OtherRAILROAD MEDICARE
1575820000OtherDEPT OF LABOR