Organization
PRIMARY HEALTH CARE CENTER OF DADE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LINDA S NIXON CFO (CHIEF FINANCIAL OFFICER)
(706) 657-7575
Entity
Organization
Contact information
Practice address
13570 N MAIN ST, TRENTON, GA 30752-2012
(706) 956-2665
(706) 657-5885
Mailing address
13570 N MAIN ST, TRENTON, GA 30752-2012
(706) 657-7575
(706) 657-6575
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000211956A
—
GA
01
—
10057286
AMERIGROUP (GA MEDICAID)
GA
01
—
336412
WELLCARE (GA MEDICAID MCO
GA
Enumeration date
05/19/2006
Last updated
01/21/2019
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