Provider Demographics
NPI:1144977802
Name:PRIME CARE & PATHOLOGY INC
Entity type:Organization
Organization Name:PRIME CARE & PATHOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JACKSON
Authorized Official - Middle Name:L
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-591-6509
Mailing Address - Street 1:1050 GREEN ST SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012-5406
Mailing Address - Country:US
Mailing Address - Phone:770-648-7226
Mailing Address - Fax:770-648-7211
Practice Address - Street 1:1050 GREEN ST SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-5406
Practice Address - Country:US
Practice Address - Phone:770-648-7226
Practice Address - Fax:770-648-7211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-03
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care