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NPI Code Detail

MEDICARE: PRIME CARE MEDICAL SERVICES INC

MEDICARE: PRIME CARE MEDICAL SERVICES INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician8433GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1811090905
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRIME CARE MEDICAL SERVICES INC
Provider Business Mailing Address
First Line : 242 SOUTH COASTAL HWY 17
Second Line :
City : MIDWAY
State : GA
Zip : 31320-5231
Country : US
Telephone Number : 912-884-3444
Fax Number : 912-884-3456
Provider Business Practice Location Address
First Line : 242 SOUTH COASTAL HWY 17
Second Line :
City : MIDWAY
State : GA
Zip : 31320-5231
Country : US
Telephone Number : 912-884-3444
Fax Number : 912-884-3456
Authorized Official
Title or Position : OWNER
Name : OLUGBENGA AWE
Credential : MD
Telephone Number : 912-884-3444
Provider Enumeration Date : 09/06/2006
Last Update Date : 05/17/2011

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Directions to “PRIME CARE MEDICAL SERVICES INC ” Practice Location

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