Healthcare Provider Details

I. General information

NPI: 1043103682
Provider Name (Legal Business Name): PRIMAL MEDICAL AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2025
Last Update Date: 06/02/2025
Certification Date: 06/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 KEITH DR STE 101
PERRY GA
31069-2948
US

IV. Provider business mailing address

PO BOX 25
FORSYTH GA
31029-0025
US

V. Phone/Fax

Practice location:
  • Phone: 478-390-6984
  • Fax:
Mailing address:
  • Phone: 478-390-6984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. LUKE WALKER
Title or Position: OWNER
Credential: MD
Phone: 478-244-1065