Provider Demographics
NPI:1891393005
Name:JUBILEE PRIMARY CARE PC
Entity Type:Organization
Organization Name:JUBILEE PRIMARY CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:AVRIL PATRICE
Authorized Official - Middle Name:DAISLEY
Authorized Official - Last Name:SHONGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-783-4860
Mailing Address - Street 1:2090 LAWRENCEVILLE SUWANEE RD
Mailing Address - Street 2:SUITE A#519
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024
Mailing Address - Country:US
Mailing Address - Phone:678-783-4860
Mailing Address - Fax:
Practice Address - Street 1:3312 HEATHCHASE LN
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4639
Practice Address - Country:US
Practice Address - Phone:678-783-4860
Practice Address - Fax:678-940-0509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2020-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty