Provider Demographics
NPI:1285277566
Name:PIONEER COMMUNITY CARE LLC
Entity type:Organization
Organization Name:PIONEER COMMUNITY CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:AYNADDIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FEKADU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-389-5513
Mailing Address - Street 1:740 PRINCE AVE STE 8B
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-5903
Mailing Address - Country:US
Mailing Address - Phone:706-389-5513
Mailing Address - Fax:
Practice Address - Street 1:740 PRINCE AVE STE 8B
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-5903
Practice Address - Country:US
Practice Address - Phone:706-389-5513
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-19
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care