Healthcare Provider Details

I. General information

NPI: 1619442829
Provider Name (Legal Business Name): PRIME CARE DAHLONEGA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2018
Last Update Date: 10/24/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 WALMART WAY STE F
DAHLONEGA GA
30533-0829
US

IV. Provider business mailing address

PO BOX 449
VIDALIA GA
30475-0449
US

V. Phone/Fax

Practice location:
  • Phone: 706-867-7666
  • Fax:
Mailing address:
  • Phone: 912-538-0640
  • Fax: 912-538-0168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LANIE WELCH
Title or Position: OWNER
Credential: NP
Phone: 912-245-1145