Provider Demographics
NPI:1669894622
Name:SMART PRIMARY CARE LLC
Entity type:Organization
Organization Name:SMART PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAVITA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-808-7283
Mailing Address - Street 1:4400 PEACHTREE RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-2729
Mailing Address - Country:US
Mailing Address - Phone:404-808-7283
Mailing Address - Fax:
Practice Address - Street 1:540 E CROSSVILLE RD
Practice Address - Street 2:SUITE 211
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-7661
Practice Address - Country:US
Practice Address - Phone:770-510-1850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-10
Last Update Date:2014-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA66516261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care