Provider Demographics
NPI:1134414105
Name:EMIR PRIMARY CARE
Entity type:Organization
Organization Name:EMIR PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:JENKINS
Authorized Official - Suffix:III
Authorized Official - Credentials:NP
Authorized Official - Phone:404-366-3647
Mailing Address - Street 1:4930 GOVERNORS DR STE 409
Mailing Address - Street 2:
Mailing Address - City:FOREST PARK
Mailing Address - State:GA
Mailing Address - Zip Code:30297-6101
Mailing Address - Country:US
Mailing Address - Phone:404-366-3647
Mailing Address - Fax:404-366-3648
Practice Address - Street 1:4930 GOVERNORS DR STE 409
Practice Address - Street 2:
Practice Address - City:FOREST PARK
Practice Address - State:GA
Practice Address - Zip Code:30297-6101
Practice Address - Country:US
Practice Address - Phone:404-366-3647
Practice Address - Fax:404-366-3648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN143268261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care