Provider Demographics
NPI:1922149079
Name:PRIMARY CARE ASSOCIATES OF ATLANTA, LLC
Entity Type:Organization
Organization Name:PRIMARY CARE ASSOCIATES OF ATLANTA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:TURNAGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-414-5611
Mailing Address - Street 1:1462 MONTREAL RD
Mailing Address - Street 2:STE 201
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-6929
Mailing Address - Country:US
Mailing Address - Phone:770-414-5611
Mailing Address - Fax:770-414-5612
Practice Address - Street 1:1462 MONTREAL RD
Practice Address - Street 2:STE 201
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6929
Practice Address - Country:US
Practice Address - Phone:770-414-5611
Practice Address - Fax:770-414-5612
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-10
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057199207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA758713451BMedicaid
GA11SCHDGMedicare PIN
GA758713451BMedicaid