Premium Life Medical Center LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

Legal business name

PREMIUM LIFE MEDICAL CENTER LLC

Practice address

639 Beaver Ruin Rd NW Ste a
Lilburn, GA 30047-3473

Phone

(678) 395-3443

Fax

(770) 837-2426

NPI assigned

Mar 6, 2023

Last updated

Mar 6, 2023By 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

Dr. Raymond Ramirez, MD

Title

Doctor Manager

Phone

(678) 395-3443

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Glenda Patricia Menendez, FNP-C

  • Family Nurse Practitioner
  • Lilburn, GA
  • NPI 1891471322
  NPD

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

{
    "created_epoch": "1678060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678060800000",
    "number": "1275233611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "639 BEAVER RUIN RD NW STE A",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300473473",
            "telephone_number": "678-395-3443",
            "fax_number": "770-837-2426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "639 BEAVER RUIN RD NW STE A",
            "city": "LILBURN",
            "state": "GA",
            "postal_code": "300473473",
            "telephone_number": "678-395-3443",
            "fax_number": "770-837-2426"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIUM LIFE MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-06",
        "last_updated": "2023-03-06",
        "certification_date": "2023-03-05",
        "status": "A",
        "authorized_official_last_name": "RAMIREZ",
        "authorized_official_first_name": "RAYMOND",
        "authorized_official_title_or_position": "DOCTOR MANAGER",
        "authorized_official_telephone_number": "678-395-3443",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Manoj Pradhan, PHARMD, RPH
• Poonam Anil Pradhan, OTR/L
• Premier MD Group Inc.
• Premier Pain Management Inc
• Premiere Dermatology and Surgery, LLC
• Lucius Kenton Presley, DMD
• Proactive Collaboration LLC
• Professional Dental Alliance of Lilburn, LLC
• Professional Services for Families
• Progressive Care of Gwinnett LLC (Progressive Healthcare of Gwinnett)

• Primary Care Clinic/Center in Lilburn, GA
• Providers in Lilburn, 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 6, 2023; 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.