Organization
PRIME DIRECT CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. BRIDGET RANDOLPH NP (OWNER/OPERATOR)
(678) 907-0663
Entity
Organization
Contact information
Practice address
9070 PERIDOT PKWY, STOCKBRIDGE, GA 30281-9417
(678) 907-0663
(770) 261-1241
Mailing address
1415 HIGHWAY 85 N STE 609, FAYETTEVILLE, GA 30214-7738
(678) 907-0663
Taxonomy
Speciality
Code
Description
License number
State
163WG0000X
General Practice Registered Nurse
Primary
—
—
Other
Enumeration date
10/22/2021
Last updated
10/22/2021
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