Provider Demographics
NPI:1548622285
Name:FOUR CORNERS PRIMARY CARE CENTERS INC
Entity type:Organization
Organization Name:FOUR CORNERS PRIMARY CARE CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-806-2928
Mailing Address - Street 1:5300 OAKBROOK PKWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30093-2256
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 TOWNE CENTER PKWY
Practice Address - Street 2:SUITE 113
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30548-2213
Practice Address - Country:US
Practice Address - Phone:770-806-2928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty