PRIMARY HEALTH CARE CENTER OF DADE INC. NPI 1891395620

NPI Information

PRIMARY HEALTH CARE CENTER OF DADE, INC. is a federally qualified health center (fqhc) clinic center in La Fayette, GA. PRIMARY HEALTH CARE CENTER OF DADE, INC. NPI is 1891395620. The provider is registered as an organization entity type.

The provider's business location address is:

10 PROBASCO ST UNIT 214
LA FAYETTE, GA
ZIP 30728-316
Phone: (706) 719-0888
Fax: (706) 657-5885

The provider's authorized official is Amy Buffington .
The authorized official title is Credentialing Director and has the following contact phone number (706) 620-4494.

The CLIA number assigned to this NPI record is 11D2102560 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/30/2020 and was last updated on 12/10/2020.

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:

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