Provider Demographics
NPI:1154117885
Name:PRIMARY HEALTH CARE CENTER OF DADE, INC.
Entity type:Organization
Organization Name:PRIMARY HEALTH CARE CENTER OF DADE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUFFINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-620-4494
Mailing Address - Street 1:100 MITCHELL RD
Mailing Address - Street 2:
Mailing Address - City:FORT OGLETHORPE
Mailing Address - State:GA
Mailing Address - Zip Code:30742-3683
Mailing Address - Country:US
Mailing Address - Phone:706-403-4122
Mailing Address - Fax:706-841-0015
Practice Address - Street 1:100 MITCHELL RD
Practice Address - Street 2:
Practice Address - City:FORT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-3683
Practice Address - Country:US
Practice Address - Phone:706-403-4122
Practice Address - Fax:706-841-0015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy