# PRIME DIRECT CARE

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

## Provider details

- **NPI number:** 1881358125
- **Authorized official:** MRS. BRIDGET RANDOLPH NP (OWNER/OPERATOR)
- **Authorized official phone:** (678) 907-0663

## Contact information

- **Practice address:** 9070 PERIDOT PKWY, STOCKBRIDGE, GA 30281-9417
- **Practice address phone:** (678) 907-0663
- **Practice address fax:** (770) 261-1241
- **Mailing address:** 1415 HIGHWAY 85 N STE 609, FAYETTEVILLE, GA 30214-7738
- **Mailing address phone:** (678) 907-0663

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163WG0000X | General Practice Registered Nurse | — | NULL | Yes |
| 163WG0000X | General Practice Registered Nurse | — | — | Yes |

## Other

- **Enumeration date:** 10/22/2021
- **Last updated:** 10/22/2021