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General NPI Number Information
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NPI Number | 1154117885
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Entity Type | Organization
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Legal Business Name | PRIMARY HEALTH CARE CENTER OF DADE, INC.
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Dates
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Enumeration Date | 04/18/2025
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 100 MITCHELL RD
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City | FORT OGLETHORPE
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State | GA
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Zip | 30742-3683
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Country | US
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Telephone | 706-403-4122
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Fax | 706-841-0015
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Provider Business Mailing Address
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Address Line | 100 MITCHELL RD
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City | FORT OGLETHORPE
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State | GA
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Zip | 30742-3683
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Country | US
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Telephone | 706-403-4122
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Fax | 706-841-0015
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Authorized Official
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Title or Position | CREDENTIALING DIRECTOR
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Name | AMY BUFFINGTON
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Credential |
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Telephone | 706-620-4494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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