MEDICARE: AIRPORT PRIMARY CARE, LLC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center	037520	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699771410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AIRPORT PRIMARY CARE, LLC.

Provider Business Mailing Address
First Line	:	3305 BOBBY BROWN PKWY
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30344-5012
Country	:	US
Telephone Number	:	404-806-8181
Fax Number	:	770-456-5469

Provider Business Practice Location Address
First Line	:	3305 BOBBY BROWN PKWY
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30344-5012
Country	:	US
Telephone Number	:	404-806-8181
Fax Number	:	770-456-5469

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SHASHIKANT A DAYA
Credential	:	M.D.
Telephone Number	:	678-471-6073

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	03/06/2017

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Directions to “AIRPORT PRIMARY CARE, LLC. ” Practice Location

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