Provider Demographics
NPI:1801639687
Name:PRIMEDOC GA LLC
Entity type:Organization
Organization Name:PRIMEDOC GA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HARUTYUN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAROYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-408-0909
Mailing Address - Street 1:3867 ROSWELL RD NE STE 100
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-4452
Mailing Address - Country:US
Mailing Address - Phone:706-408-0909
Mailing Address - Fax:
Practice Address - Street 1:3867 ROSWELL RD NE STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-4452
Practice Address - Country:US
Practice Address - Phone:706-408-0909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty