# PRIMECARE CLINIC, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194940452
- **Authorized official:** BARBARA NKOMAZANA (PRACTICE MANAGER)
- **Authorized official phone:** (731) 376-1851

## Contact information

- **Practice address:** 622 NUCKOLLS RD, BOLIVAR, TN 38008-1532
- **Practice address phone:** (731) 658-2120
- **Mailing address:** PO BOX 479, BOLIVAR, TN 38008-0479

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 25889 | TN | Yes |
| 207R00000X | Internal Medicine Physician | 38934 | TN | — |

## Other

- **Enumeration date:** 04/13/2007
- **Last updated:** 04/07/2010