Healthcare Provider Details

I. General information

NPI: 1154117885
Provider Name (Legal Business Name): PRIMARY HEALTH CARE CENTER OF DADE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2025
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MITCHELL RD
FORT OGLETHORPE GA
30742-3683
US

IV. Provider business mailing address

100 MITCHELL RD
FORT OGLETHORPE GA
30742-3683
US

V. Phone/Fax

Practice location:
  • Phone: 706-403-4122
  • Fax: 706-841-0015
Mailing address:
  • Phone: 706-403-4122
  • Fax: 706-841-0015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AMY BUFFINGTON
Title or Position: CREDENTIALING DIRECTOR
Credential:
Phone: 706-620-4494