Healthcare Provider Details

I. General information

NPI: 1083958623
Provider Name (Legal Business Name): STAR FAMILY HEALTHCARE AND WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2012
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5337 OLD NATIONAL HWY SUITE 100
COLLEGE PARK GA
30349-3208
US

IV. Provider business mailing address

5337 OLD NATIONAL HWY SUITE 100
COLLEGE PARK GA
30349-3208
US

V. Phone/Fax

Practice location:
  • Phone: 404-767-7777
  • Fax: 404-767-7770
Mailing address:
  • Phone: 404-767-7777
  • Fax: 404-767-7770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN145805
License Number StateGA

VIII. Authorized Official

Name: DR. HELEN ONYEDIKACHI UZOKWE
Title or Position: OWNER
Credential: DNP, FMP
Phone: 404-767-7777