| Organization Name: | IMC PRIMERA LLC |
| NPI Number: | 1609119882 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SHAILESH KOTHARI (OWNER) |
| Mailing Address: | 800 Virginia Ave Suite 200 Hapeville |
| State: | GA US |
| Postal Code: | 303544302 |
| Phone Number: | 8883112976 |
| Fax Number: | 4045493393 |
| NPI Enumeration Date: | 04/05/2013 |
| NPI Last Update Date: | 04/05/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |