Healthcare Provider Details

I. General information

NPI: 1093319881
Provider Name (Legal Business Name): DREEM FACTORY MEDICAL INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2296 HENDERSON MILL RD NE STE 304
ATLANTA GA
30345-2739
US

IV. Provider business mailing address

2296 HENDERSON MILL RD NE STE 304
ATLANTA GA
30345-2739
US

V. Phone/Fax

Practice location:
  • Phone: 404-721-5080
  • Fax:
Mailing address:
  • Phone: 404-721-5080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MOHAMMED LUWEMBA
Title or Position: PRESIDENT
Credential:
Phone: 404-721-5080