Healthcare Provider Details

I. General information

NPI: 1538912423
Provider Name (Legal Business Name): FIRSTSTOP MEDICAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2024
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3375 MEMORIAL DR STE G
DECATUR GA
30032-2706
US

IV. Provider business mailing address

3375 MEMORIAL DR STE G
DECATUR GA
30032-2706
US

V. Phone/Fax

Practice location:
  • Phone: 404-494-6774
  • Fax:
Mailing address:
  • Phone: 470-446-2137
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GLORY DIOH-ESONA
Title or Position: OWNER
Credential: FNP
Phone: 404-494-6774