Provider Demographics
NPI:1700974631
Name:PREMIUM MEDICAL CARE,LLC
Entity Type:Organization
Organization Name:PREMIUM MEDICAL CARE,LLC
Other - Org Name:PREMIUM MEDICAL CARE,LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:KAREEM
Authorized Official - Middle Name:A
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-474-1698
Mailing Address - Street 1:233 MITCHELL ST SW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30303-3304
Mailing Address - Country:US
Mailing Address - Phone:404-437-7741
Mailing Address - Fax:404-474-3089
Practice Address - Street 1:233 MITCHELL ST SW
Practice Address - Street 2:SUITE 300
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3304
Practice Address - Country:US
Practice Address - Phone:404-437-7741
Practice Address - Fax:404-474-3089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA119338LGB173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========Medicare ID - Type UnspecifiedTAX ID