Healthcare Provider Details

I. General information

NPI: 1801743042
Provider Name (Legal Business Name): COMPREHENSIVE PRIMARY CARE AND ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 CROSSROADS DR
OWINGS MILLS MD
21117-5421
US

IV. Provider business mailing address

627 WINDRIFT DR
DALLAS GA
30132-9094
US

V. Phone/Fax

Practice location:
  • Phone: 301-869-9776
  • Fax:
Mailing address:
  • Phone: 678-986-2220
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JULIE HILTON
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 678-986-2220