Healthcare Provider Details

I. General information

NPI: 1417323387
Provider Name (Legal Business Name): MEDPRIME NORTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2015
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 LAUREL SPRINGS PKWY SUITE 1402
SUWANEE GA
30024-6056
US

IV. Provider business mailing address

5400 LAUREL SPRINGS PKWY SUITE 1402
SUWANEE GA
30024-6056
US

V. Phone/Fax

Practice location:
  • Phone: 678-965-0586
  • Fax: 678-455-6125
Mailing address:
  • Phone: 678-965-0586
  • Fax: 678-455-6125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. AMIE HUNTER CHEEK
Title or Position: OFFICE MANAGER
Credential: CPC
Phone: 770-401-8610