Provider Demographics
NPI:1295924157
Name:PHYSICIANS PRIMARY CARE GROUP INC.
Entity type:Organization
Organization Name:PHYSICIANS PRIMARY CARE GROUP INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, ADMINISTRATIVE SERVICES
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NEELY PENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-755-2291
Mailing Address - Street 1:PO BOX 42248
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30311-0248
Mailing Address - Country:US
Mailing Address - Phone:404-755-2291
Mailing Address - Fax:404-755-5377
Practice Address - Street 1:2391 BENJAMIN E MAYS DR SW
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30311-3251
Practice Address - Country:US
Practice Address - Phone:404-755-2291
Practice Address - Fax:404-755-5377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA097671 LGB111N00000X, 213ES0131X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty