=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144084856
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GEORGIA PRIMARY CARE PARTNERS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/13/2024
-----------------------------------------------------
Last Update Date | 09/19/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 60 EXCHANGE ST STE B7
-----------------------------------------------------
City | RICHMOND HILL
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31324-7646
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-756-2273
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9390 FORD AVE STE 2
-----------------------------------------------------
City | RICHMOND HILL
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31324-6418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 912-915-2275
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. WALTER PORTER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 912-915-2275
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------