Healthcare Provider Details

I. General information

NPI: 1194396846
Provider Name (Legal Business Name): PRYME COMMUNITY CLINIC INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2021
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6201 GREENBELT RD STE M8A
BERWYN HEIGHTS MD
20740-2358
US

IV. Provider business mailing address

6201 GREENBELT RD STE M8A
BERWYN HEIGHTS MD
20740-2358
US

V. Phone/Fax

Practice location:
  • Phone: 240-413-0052
  • Fax: 301-358-2940
Mailing address:
  • Phone: 240-413-0052
  • Fax: 301-358-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LINDA R WILLIAMS
Title or Position: OWNER OF ENTITY
Credential: MSN, CRNP FAMILY
Phone: 240-413-0052