Provider Demographics
NPI:1699771410
Name:AIRPORT PRIMARY CARE, LLC.
Entity type:Organization
Organization Name:AIRPORT PRIMARY CARE, LLC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHASHIKANT
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-471-6073
Mailing Address - Street 1:3305 BOBBY BROWN PKWY
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30344-5012
Mailing Address - Country:US
Mailing Address - Phone:404-806-8181
Mailing Address - Fax:770-456-5469
Practice Address - Street 1:3305 BOBBY BROWN PKWY
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30344-5012
Practice Address - Country:US
Practice Address - Phone:404-806-8181
Practice Address - Fax:770-456-5469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA037520261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA360335904BMedicaid
GA360335904BMedicaid
GAGRP7052Medicare PIN
GA08BBRTJMedicare PIN