PRIME DIRECT CARE NPI 1881358125

NPI Information

NPI: 1881358125
Provider Name: PRIME DIRECT CARE
Classification: Registered Nurse - 163WG0000X
Entity Type: Organization

Specialization: General Practice

CLIA Number: 11D2228485

Address:
9070 PERIDOT PKWY
STOCKBRIDGE, GA
ZIP 30281
Phone: (678) 907-0663
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PRIME DIRECT CARE is a general practice registered nurse in Stockbridge, GA. PRIME DIRECT CARE NPI is 1881358125. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

9070 PERIDOT PKWY
STOCKBRIDGE, GA
ZIP 30281-417
Phone: (678) 907-0663
Fax: (770) 261-1241

The provider's authorized official is Bridget Randolph .
The authorized official title is Owner/operator and has the following contact phone number (678) 907-0663.

The CLIA number assigned to this NPI record is 11D2228485 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/22/2021 and was last updated on 10/22/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	163WG0000X	Registered Nurse	General Practice			Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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