MEDICARE: PRIME FAMILY MEDICINE AND WELLNESS CENTER 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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1922985621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIME FAMILY MEDICINE AND WELLNESS CENTER LLC

Provider Business Mailing Address
First Line	:	2009 LAWRENCEVILLE SUWANEE RD STE 100
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-2612
Country	:	US
Telephone Number	:	770-255-4575
Fax Number	:	770-274-6332

Provider Business Practice Location Address
First Line	:	2009 LAWRENCEVILLE SUWANEE RD STE 100
Second Line	:
City	:	SUWANEE
State	:	GA
Zip	:	30024-2612
Country	:	US
Telephone Number	:	770-255-4575
Fax Number	:	770-274-6332

Authorized Official
Title or Position	:	REGISTERED NURSE
Name	:	KAREN SCHNEIDER
Credential	:	RN
Telephone Number	:	678-887-0565

Provider Enumeration Date	:	08/18/2025
Last Update Date	:	08/18/2025

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