Healthcare Provider Details

I. General information

NPI: 1578455200
Provider Name (Legal Business Name): FLORENCE PRIMARY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2025
Last Update Date: 08/12/2025
Certification Date: 08/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4155 S LEE ST STE B100
BUFORD GA
30518-3649
US

IV. Provider business mailing address

4155 S LEE ST STE B100
BUFORD GA
30518-3649
US

V. Phone/Fax

Practice location:
  • Phone: 470-735-8149
  • Fax: 678-563-6061
Mailing address:
  • Phone: 470-735-8149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: NEELIMA DACHURI
Title or Position: MD
Credential: MD
Phone: 470-735-8149