MEDICARE: PRIMECARE ABA

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1740028117
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMECARE ABA

Provider Business Mailing Address
First Line	:	50 HURT PLZ SE STE 3A
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30303-2946
Country	:	US
Telephone Number	:	478-788-0348
Fax Number	:

Provider Business Practice Location Address
First Line	:	1735 IRWINTON RD STE 3A
Second Line	:
City	:	MILLEDGEVILLE
State	:	GA
Zip	:	31061-3830
Country	:	US
Telephone Number	:	470-788-0348
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CALEB FLOURNOY
Credential	:
Telephone Number	:	478-345-0523

Provider Enumeration Date	:	07/18/2024
Last Update Date	:	07/18/2024

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