Healthcare Provider Details

I. General information

NPI: 1700974631
Provider Name (Legal Business Name): PREMIUM MEDICAL CARE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 MITCHELL ST SW SUITE 300
ATLANTA GA
30303-3304
US

IV. Provider business mailing address

233 MITCHELL ST SW SUITE 300
ATLANTA GA
30303-3304
US

V. Phone/Fax

Practice location:
  • Phone: 404-437-7741
  • Fax: 404-474-3089
Mailing address:
  • Phone: 404-437-7741
  • Fax: 404-474-3089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number119338LGB
License Number StateGA

VIII. Authorized Official

Name: MR. KAREEM A MYERS
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 404-474-1698