| Premier Primary Care, Llc | |
|
2121 Fountain Dr Ste A Snellville GA 30078-2900 | |
| (770) 736-3008 | |
| (770) 687-2296 |
| Full Name | Premier Primary Care, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2121 Fountain Dr Ste A, Snellville, Georgia |
| Authorized Official Name and Position | Amanda Crawford (PRACTICE ADMINISTRATOR) |
| Authorized Official Contact | 7707363008 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Primary Care, Llc 2121 Fountain Dr Ste A Snellville GA 30078-2900 Ph: (770) 736-3008 | Premier Primary Care, Llc 2121 Fountain Dr Ste A Snellville GA 30078-2900 Ph: (770) 736-3008 |
| NPI Number | 1154887925 |
|---|---|
| Provider Enumeration Date | 02/15/2019 |
| Last Update Date | 07/19/2019 |
| Medicare PECOS PAC ID | 4880936970 |
|---|---|
| Medicare Enrollment ID | O20190418002386 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154887925 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Daryl Sherrod |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851354740 PECOS PAC ID: 5799760609 Enrollment ID: I20040623000747 |
| Provider Name | Jose Dominguez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295835775 PECOS PAC ID: 6709060403 Enrollment ID: I20110404000822 |
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