Provider Demographics
NPI:1902961261
Name:THE PRIMARY CARE CENTER, PC
Entity Type:Organization
Organization Name:THE PRIMARY CARE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:404-325-9600
Mailing Address - Street 1:PO BOX 28218
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30358-0218
Mailing Address - Country:US
Mailing Address - Phone:404-298-0008
Mailing Address - Fax:404-298-0087
Practice Address - Street 1:2891-C NORTH DECATUR ROAD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033
Practice Address - Country:US
Practice Address - Phone:404-298-0008
Practice Address - Fax:404-298-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037451207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00586407DMedicaid
GAGRP8080OtherMEDICARE GROUP
GA618571OtherBLUE CROSS GROUP