Healthcare Provider Details

I. General information

NPI: 1275446338
Provider Name (Legal Business Name): HEALTHYCONNECT PRIMARY CARE OF GEORGIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
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: 813-760-3373
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name: FREDERICK BURRIS
Title or Position: CEO
Credential:
Phone: 813-334-7442