Healthcare Provider Details

I. General information

NPI: 1740311711
Provider Name (Legal Business Name): PREMIER PRIMARY CARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 OLD NATIONAL HWY
COLLEGE PARK GA
30349-3838
US

IV. Provider business mailing address

5820 OLD NATIONAL HWY SUITE 250
COLLEGE PARK GA
30349-3838
US

V. Phone/Fax

Practice location:
  • Phone: 770-997-1565
  • Fax: 770-997-1568
Mailing address:
  • Phone: 770-997-1565
  • Fax: 770-997-1568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number039888
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number039888
License Number StateGA

VIII. Authorized Official

Name: DR. CHRISTAIN C. OHAGWU
Title or Position: CEO
Credential: M.D.
Phone: 404-766-1970