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General NPI Number Information
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NPI Number | 1457770612
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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 | 04/15/2014
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Last Update Date | 04/15/2014
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Provider Practice Location Address
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Address Line | 11638 HIGHWAY 27 SUITE 8
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City | SUMMERVILLE
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State | GA
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Zip | 30747-8514
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Country | US
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Telephone | 706-657-7575
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Fax |
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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 |
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Authorized Official
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Title or Position | ADMINISTRATIVE SERVICES MANAGER
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Name | AMY L BUFFINGTON
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Credential |
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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 | 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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