Provider Demographics
NPI:1245813807
Name:MOBILE PRIMARY CARE, LLC
Entity type:Organization
Organization Name:MOBILE PRIMARY CARE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNS
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:240-389-0227
Mailing Address - Street 1:4303 HARBOUR TOWN DR
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-1078
Mailing Address - Country:US
Mailing Address - Phone:240-389-0227
Mailing Address - Fax:833-992-2121
Practice Address - Street 1:4303 HARBOUR TOWN DR
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-1078
Practice Address - Country:US
Practice Address - Phone:240-389-0227
Practice Address - Fax:833-992-2121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-03
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care