NPI 1205288164

Medprime Brookhaven

Organisation Preferred Provider Organization Atlanta, GA

Practice location

Address: 2 Concourse Pkwy Suite 100, Atlanta, GA 30328-5371
Phone: (678) 691-8239
Mailing address: 1100 Peachtree St NE Suite 200, Atlanta, GA 30309-4501

Authorised official

Name: Sherwin Eugene Bryant
Title: Compliance Officer
Phone: (678) 691-8239

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence 61430 (GA)

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Registry record

NPI: 1205288164
Entity type: Organization
NPI issued: 4 Jul 2016
Record last updated: 4 Jul 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.