1770730517 NPI number — FATHER'S LOVE MEDICAL CENTER

Table of content: (NPI 1770730517)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770730517 NPI number — FATHER'S LOVE MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FATHER'S LOVE MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FATHER'S LOVE MEDICALS, FLMC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770730517
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7768 HAMPTON PL
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
LOGANVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30052-6770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-466-7737
Provider Business Mailing Address Fax Number:
770-466-8824

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7768 HAMPTON PL
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LOGANVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30052-6770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-466-7737
Provider Business Practice Location Address Fax Number:
770-466-8824
Provider Enumeration Date:
08/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
OHUABUNWO
Authorized Official First Name:
CHIMA
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
DIRECTOR OF HEALTH MGT. AND ADMIN.
Authorized Official Telephone Number:
678-557-9508

Provider Taxonomy Codes

  • Taxonomy code: 261QC1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QH0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X , with the licence number: 060582 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X , with the licence number: 055776 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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