Provider Demographics
NPI:1154539880
Name:PRIORITY CARE MEDICAL CENTER
Entity type:Organization
Organization Name:PRIORITY CARE MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:K
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:NPC
Authorized Official - Phone:706-937-2777
Mailing Address - Street 1:6553 HIGHWAY 41
Mailing Address - Street 2:
Mailing Address - City:RINGGOLD
Mailing Address - State:GA
Mailing Address - Zip Code:30736-2641
Mailing Address - Country:US
Mailing Address - Phone:706-937-2777
Mailing Address - Fax:
Practice Address - Street 1:6553 HIGHWAY 41
Practice Address - Street 2:
Practice Address - City:RINGGOLD
Practice Address - State:GA
Practice Address - Zip Code:30736-2641
Practice Address - Country:US
Practice Address - Phone:706-937-2777
Practice Address - Fax:706-937-3012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAR117550363LF0000X
GARN161233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA=========OtherGROUP
GAP28331Medicare UPIN
GAE16159Medicare UPIN