Healthcare Provider Details

I. General information

NPI: 1881629384
Provider Name (Legal Business Name): PRIME CARE FAMILY PRACTICE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 PUDDLEDOCK ROAD SUITE 300
PRINCE GEORGE VA
23875-1268
US

IV. Provider business mailing address

4700 PUDDLEDOCK ROAD SUITE 300
PRINCE GEORGE VA
23875-1268
US

V. Phone/Fax

Practice location:
  • Phone: 804-526-1111
  • Fax: 804-526-8363
Mailing address:
  • Phone: 804-526-1111
  • Fax: 804-526-8363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. DEIDRA F. MANN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 804-526-1111