Prime Care & Pathology Inc

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

PRIME CARE & PATHOLOGY INC

Practice address

1050 Green St SE
Conyers, GA 30012-5406

Phone

(770) 648-7226

Fax

(770) 648-7211

NPI assigned

Mar 3, 2022

Organization subpart

No

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

Authorized official

Name

Dr. Jackson L Gates, MDNPI 1962418400

Title

Owner

Phone

(678) 591-6509

Specialties & licenses 1

Addresses

Other names 1

• Jackson L Gates Doing business as

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jackson L Gates, M.D.

  • General Practice Physician
  • Conyers, GA
  • NPI 1962418400
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1646265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1646265600000",
    "number": "1144977802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 GREEN ST SE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300125406",
            "telephone_number": "770-648-7226",
            "fax_number": "770-648-7211"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 GREEN ST SE",
            "city": "CONYERS",
            "state": "GA",
            "postal_code": "300125406",
            "telephone_number": "770-648-7226",
            "fax_number": "770-648-7211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME CARE & PATHOLOGY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-03-03",
        "last_updated": "2022-03-03",
        "certification_date": "2022-03-02",
        "status": "A",
        "authorized_official_last_name": "GATES",
        "authorized_official_first_name": "JACKSON",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "678-591-6509",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson L Gates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Primary Care Clinic/Center in Conyers, GA
• Providers in Conyers, GA by specialty
• Primary Care Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.