Primacare Pain & Rehab.,LLC

Primary specialty

Pain Clinic/CenterTaxonomy code 261QP3300X

License

019313 Issued in GA

Legal business name

PRIMACARE PAIN & REHAB.,LLC

Practice address

4467 Glenwood Rd
Suite 2
Decatur, GA 30032-5014

Phone

(404) 284-5556

Fax

(404) 284-5557

NPI assigned

Apr 30, 2010

Last updated

Apr 30, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Khamis W Ibrahim, D.C.

Title

Clinic Director

Phone

(404) 284-5556

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1272585600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1272585600000",
    "number": "1043537905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4467 GLENWOOD RD",
            "address_2": "SUITE 2",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300325014",
            "telephone_number": "404-284-5556",
            "fax_number": "404-284-5557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4467 GLENWOOD RD",
            "address_2": "SUITE 2",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300325014",
            "telephone_number": "404-284-5556",
            "fax_number": "404-284-5557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMACARE PAIN & REHAB.,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-04-30",
        "last_updated": "2010-04-30",
        "status": "A",
        "authorized_official_last_name": "IBRAHIM",
        "authorized_official_first_name": "KHAMIS",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "404-284-5556",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": "GA",
            "license": "019313",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Price
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• Bradford Hollace Priddy, M.D.
• Primary Medical Care Group
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• Prime Comfort Transport LLC
• Prime Regen Decatur

• Pain Clinic/Center in Decatur, GA
• Providers in Decatur, GA by specialty
• Pain Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.