Healthcare Provider Details

I. General information

NPI: 1326950171
Provider Name (Legal Business Name): PRIMAL HEALTHCARE SYSTEMS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 ATLANTA RD SE STE 102
SMYRNA GA
30080-1541
US

IV. Provider business mailing address

3645 MARKETPLACE BLVD STE 130
EAST POINT GA
30344-5940
US

V. Phone/Fax

Practice location:
  • Phone: 404-421-4260
  • Fax:
Mailing address:
  • Phone: 404-421-4260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: VENETTA MWENGELLA
Title or Position: OWNER
Credential:
Phone: 404-421-4260