Provider Demographics
NPI:1588169759
Name:TREKEN PRIMARY CARE INC
Entity type:Organization
Organization Name:TREKEN PRIMARY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:CHERYLANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:FARNUM
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:404-305-0004
Mailing Address - Street 1:777 CLEVELAND AVE SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30315-7129
Mailing Address - Country:US
Mailing Address - Phone:404-305-0004
Mailing Address - Fax:404-305-0494
Practice Address - Street 1:777 CLEVELAND AVE SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30315-7129
Practice Address - Country:US
Practice Address - Phone:404-305-0004
Practice Address - Fax:404-305-0494
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-28
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent MedicineGroup - Single Specialty