Healthcare Provider Details

I. General information

NPI: 1386555209
Provider Name (Legal Business Name): PRIMARY SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

2206 HANFRED LN STE 101
TUCKER GA
30084-4809
US

IV. Provider business mailing address

2206 HANFRED LN STE 101
TUCKER GA
30084-4809
US

V. Phone/Fax

Practice location:
  • Phone: 678-641-2446
  • Fax:
Mailing address:
  • Phone: 678-641-2446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: OSCAR KYSER
Title or Position: DIRECTOR
Credential:
Phone: 678-641-2446