Healthcare Provider Details

I. General information

NPI: 1164614194
Provider Name (Legal Business Name): PRIME COMMUNITY HEALTH GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 METROPOLITAN PKWY SW
ATLANTA GA
30315-5926
US

IV. Provider business mailing address

3435 KINGSBORO RD NE 1804
ATLANTA GA
30326-1344
US

V. Phone/Fax

Practice location:
  • Phone: 404-505-7500
  • Fax: 404-505-1238
Mailing address:
  • Phone: 404-505-7500
  • Fax: 404-846-5561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4943
License Number StateGA

VIII. Authorized Official

Name: DR. VERNICE RENEE ROBINSON
Title or Position: CHIROPRATOR
Credential: D. C.
Phone: 404-505-7500