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General NPI Number Information
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NPI Number | 1437102449
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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 | 05/19/2006
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Last Update Date | 01/21/2019
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Provider Practice Location Address
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Address Line | 13570 N MAIN ST
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City | TRENTON
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State | GA
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Zip | 30752-2012
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Country | US
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Telephone | 706-956-2665
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Fax | 706-657-5885
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Provider Business Mailing Address
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Address Line | 13570 N MAIN ST
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City | TRENTON
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State | GA
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Zip | 30752-2012
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Country | US
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Telephone | 706-657-7575
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Fax | 706-657-6575
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | LINDA S NIXON
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Credential | CFO
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Telephone | 706-657-7575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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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 | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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