Healthcare Provider Details

I. General information

NPI: 1700719770
Provider Name (Legal Business Name): HEALTHYCONNECT PRIMARY CARE OF GEORGIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 HIGHWAY 41 S STE C
FORSYTH GA
31029-8799
US

IV. Provider business mailing address

4030 HENDERSON BLVD STE 598
TAMPA FL
33629-4940
US

V. Phone/Fax

Practice location:
  • Phone: 813-334-7442
  • Fax: 813-579-1005
Mailing address:
  • Phone: 813-334-7442
  • Fax: 813-579-1005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. FREDERICK ANTHONY BURRIS
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 813-334-7442