Provider Demographics
NPI:1457072647
Name:GEM PRIMARY HEALTHCARE, LLC.
Entity Type:Organization
Organization Name:GEM PRIMARY HEALTHCARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NP
Authorized Official - Prefix:
Authorized Official - First Name:GERALDINE
Authorized Official - Middle Name:ECCLESTON
Authorized Official - Last Name:MENCHION
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:404-514-6066
Mailing Address - Street 1:175 COUNTRY CLUB DR BLDG 100D
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7380
Mailing Address - Country:US
Mailing Address - Phone:678-819-5497
Mailing Address - Fax:678-601-1508
Practice Address - Street 1:175 COUNTRY CLUB DR BLDG 100D
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7380
Practice Address - Country:US
Practice Address - Phone:678-819-5497
Practice Address - Fax:678-601-1508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-07
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care