Primary Health Care Center of Dade, Inc.

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

Legal business name

PRIMARY HEALTH CARE CENTER OF DADE, INC.

Practice address

87 S Burnt Mill Rd
La Fayette, GA 30728-4263

Phone

(706) 620-4494

Fax

(706) 657-2958

NPI assigned

Nov 30, 2015

Organization subpart

No

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

Authorized official

Name

Diana U Allen

Title

Ceo

Phone

(706) 620-4494

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1448841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1448841600000",
    "number": "1356715452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13570 N MAIN ST",
            "city": "TRENTON",
            "state": "GA",
            "postal_code": "307522012",
            "telephone_number": "706-956-2665",
            "fax_number": "706-657-2958"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "87 S BURNT MILL RD",
            "city": "LA FAYETTE",
            "state": "GA",
            "postal_code": "307284263",
            "telephone_number": "706-620-4494",
            "fax_number": "706-657-2958"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY HEALTH CARE CENTER OF DADE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-11-30",
        "last_updated": "2015-11-30",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "DIANA",
        "authorized_official_middle_name": "U",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "706-620-4494"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Federally Qualified Health Center (FQHC) in La Fayette, GA
• Providers in La Fayette, GA by specialty
• Federally Qualified Health Center (FQHC) in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2015; 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.