Healthcare Provider Details

I. General information

NPI: 1972258002
Provider Name (Legal Business Name): PRIME CARE OF GEORGIA II LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 TOWNE CENTER BLVD STE 604
POOLER GA
31322-4070
US

IV. Provider business mailing address

1000 TOWNE CENTER BLVD STE 604
POOLER GA
31322-4070
US

V. Phone/Fax

Practice location:
  • Phone: 912-561-7001
  • Fax: 912-561-7002
Mailing address:
  • Phone: 912-561-7001
  • Fax: 912-561-7002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. NEHA KHAROD
Title or Position: PHYSICIAN
Credential: MD
Phone: 912-561-7001