Provider Demographics
NPI:1427455575
Name:PRIMERA HEALTH AND WELLNESS
Entity type:Organization
Organization Name:PRIMERA HEALTH AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAILESH
Authorized Official - Middle Name:SUSHIL
Authorized Official - Last Name:KOTHARI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:678-904-7564
Mailing Address - Street 1:3060 PEACHTREE RD NW
Mailing Address - Street 2:SUITE 965
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-2234
Mailing Address - Country:US
Mailing Address - Phone:678-904-7564
Mailing Address - Fax:
Practice Address - Street 1:3060 PEACHTREE RD NW
Practice Address - Street 2:SUITE 965
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-2234
Practice Address - Country:US
Practice Address - Phone:678-904-7564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4838208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty