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General NPI Number Information
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NPI Number | 1093356685
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE SOUTH, INC
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Dates
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Enumeration Date | 10/04/2019
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Last Update Date | 10/10/2022
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Provider Practice Location Address
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Address Line | 5551 US HIGHWAY 98
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459
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Country | US
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Telephone | 850-420-5420
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Fax | 850-244-8011
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Provider Business Mailing Address
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Address Line | 5551 US HIGHWAY 98
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City | SANTA ROSA BEACH
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State | FL
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Zip | 32459
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Country | US
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Telephone | 850-420-5420
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Fax | 850-244-8011
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Authorized Official
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Title or Position | CREDENTIAL
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Name | KIMMIE HUNTER
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Credential |
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Telephone | 850-420-5420
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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