Organization
COMMUNITY PRIMARY CARE OF GEORGIA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIZE JOSEPH (DIRECTOR OF PRACTICE MANAGEMENT)
(478) 621-2100
Entity
Organization
Contact information
Practice address
1005 BOULDER DR, GRAY, GA 31032-6141
(478) 621-2100
(478) 744-0481
Mailing address
1005 BOULDER DR, GRAY, GA 31032-6141
(478) 621-2100
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
10/25/2012
Last updated
06/28/2019
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