Provider Demographics
NPI:1396924635
Name:PRIME IMMEDIATE CARE LLC
Entity type:Organization
Organization Name:PRIME IMMEDIATE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAMKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-635-8163
Mailing Address - Street 1:9280 HWY 5
Mailing Address - Street 2:SUITE E
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-1501
Mailing Address - Country:US
Mailing Address - Phone:770-635-8163
Mailing Address - Fax:770-635-8254
Practice Address - Street 1:9280 HIGHWAY 5 STE E
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-1501
Practice Address - Country:US
Practice Address - Phone:770-635-8163
Practice Address - Fax:770-635-8254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-02
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA93BBKHDMedicare PIN