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General NPI Number Information
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NPI Number | 1861452492
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Entity Type | Organization
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Legal Business Name | PRIMARY MEDICAL CARE
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Dates
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Enumeration Date | 03/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1287 HWY 138 SPUR SUITE #8
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City | JONESBORO
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State | GA
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Zip | 30236
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Country | US
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Telephone | 770-471-9990
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Fax | 770-471-4290
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Provider Business Mailing Address
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Address Line | 1287 HWY 138 SPUR SUITE #8
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City | JONESBORO
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State | GA
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Zip | 30236
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Country | US
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Telephone | 770-471-9990
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Fax | 770-471-4290
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Authorized Official
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Title or Position | MD
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Name | MRS. LOUELINA M SOOD
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Credential | MD
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Telephone | 770-471-9990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | O21592
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License Number State | GA
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