Healthcare Provider Details

I. General information

NPI: 1477666782
Provider Name (Legal Business Name): PRIMARY HEALTHCARE CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 TALLULAH TRL
WARNER ROBINS GA
31088-7625
US

IV. Provider business mailing address

644 TALLULAH TRL
WARNER ROBINS GA
31088
US

V. Phone/Fax

Practice location:
  • Phone: 478-328-2600
  • Fax: 478-923-0055
Mailing address:
  • Phone: 478-328-2600
  • Fax: 478-923-0055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: WILLIAM A WOOLERY
Title or Position: CEO
Credential: D.O.
Phone: 478-328-2600