Provider Demographics
NPI:1003050238
Name:BRICK CITY PRIMARY CARE, PLLC
Entity type:Organization
Organization Name:BRICK CITY PRIMARY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-776-7725
Mailing Address - Street 1:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27331-0237
Mailing Address - Country:US
Mailing Address - Phone:919-776-7725
Mailing Address - Fax:919-776-0511
Practice Address - Street 1:125 CHATHAM ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-4335
Practice Address - Country:US
Practice Address - Phone:919-776-7725
Practice Address - Fax:919-776-0511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9700960207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG38837OtherUPIN
NC8911033Medicaid
NC2248895Medicare PIN