| Prikare Pc | |
|
2350 Limestone Pkwy Gainesville GA 30501-2013 | |
| (770) 539-9600 | |
| (770) 539-9605 |
| Full Name | Prikare Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2350 Limestone Pkwy, Gainesville, Georgia |
| Authorized Official Name and Position | Kenneth Willoughby Fogarty (OWNER) |
| Authorized Official Contact | 7705399600 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prikare Pc 2350 Limestone Pkwy Gainesville GA 30501-2013 Ph: (770) 539-9600 | Prikare Pc 2350 Limestone Pkwy Gainesville GA 30501-2013 Ph: (770) 539-9600 |
| NPI Number | 1528407608 |
|---|---|
| Provider Enumeration Date | 06/21/2013 |
| Last Update Date | 05/15/2014 |
| Medicare PECOS PAC ID | 7719110279 |
|---|---|
| Medicare Enrollment ID | O20140507001797 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528407608 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 041118 (Georgia) | Primary |
| Provider Name | Kenneth W Fogarty |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396725214 PECOS PAC ID: 8123160728 Enrollment ID: I20100120000491 |
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