Provider Demographics
NPI:1992994545
Name:PRIMECARE MEDICAL CENTER OF CUMMING LLC
Entity type:Organization
Organization Name:PRIMECARE MEDICAL CENTER OF CUMMING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:RICE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-292-9982
Mailing Address - Street 1:2021 MARKET PLACE BLVD
Mailing Address - Street 2:CUMMING TOWN CENTER
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-7931
Mailing Address - Country:US
Mailing Address - Phone:770-292-9982
Mailing Address - Fax:770-292-9984
Practice Address - Street 1:2021 MARKET PLACE BLVD
Practice Address - Street 2:CUMMING TOWN CENTER
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-7931
Practice Address - Country:US
Practice Address - Phone:770-292-9982
Practice Address - Fax:770-292-9984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-19
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047251261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care