MEDICARE: PRIMARY HEALTH CARE CENTER OF DADE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	333600000X	Pharmacy
2	3336S0011X	Specialty Pharmacy
3	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1154117885
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY HEALTH CARE CENTER OF DADE, INC.

Provider Business Mailing Address
First Line	:	100 MITCHELL RD
Second Line	:
City	:	FORT OGLETHORPE
State	:	GA
Zip	:	30742-3683
Country	:	US
Telephone Number	:	706-403-4122
Fax Number	:	706-841-0015

Provider Business Practice Location Address
First Line	:	100 MITCHELL RD
Second Line	:
City	:	FORT OGLETHORPE
State	:	GA
Zip	:	30742-3683
Country	:	US
Telephone Number	:	706-403-4122
Fax Number	:	706-841-0015

Authorized Official
Title or Position	:	CREDENTIALING DIRECTOR
Name	:	AMY BUFFINGTON
Credential	:
Telephone Number	:	706-620-4494

Provider Enumeration Date	:	04/18/2025
Last Update Date	:	04/18/2025

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