| Primary Medical Llc | |
|
4390 Cedar Bridge Walk Suwanee GA 30024-1323 | |
| (469) 442-8584 | |
| Not Available |
| Full Name | Primary Medical Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 4390 Cedar Bridge Walk, Suwanee, Georgia |
| Authorized Official Name and Position | Ravi K Pasupuleti (OWENER) |
| Authorized Official Contact | 4694428584 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary Medical Llc 4390 Cedar Bridge Walk Suwanee GA 30024-1323 Ph: (469) 442-8584 | Primary Medical Llc 4390 Cedar Bridge Walk Suwanee GA 30024-1323 Ph: (469) 442-8584 |
| NPI Number | 1275918914 |
|---|---|
| Provider Enumeration Date | 07/23/2015 |
| Last Update Date | 07/23/2015 |
| Medicare PECOS PAC ID | 7618932286 |
|---|---|
| Medicare Enrollment ID | O20151001000931 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1275918914 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 71848 (Georgia) | Primary |
| Provider Name | Ravi Pasupuleti |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295134245 PECOS PAC ID: 3971811589 Enrollment ID: I20151001001124 |
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