Healthcare Provider Details

I. General information

NPI: 1447616255
Provider Name (Legal Business Name): COVENANT PULMONARY CRITICAL CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2016
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1136 CLEVELAND AVE SUITE 615
EAST POINT GA
30344-3618
US

IV. Provider business mailing address

1136 CLEVELAND AVE SUITE 615
EAST POINT GA
30344-3618
US

V. Phone/Fax

Practice location:
  • Phone: 404-254-5388
  • Fax: 404-565-1255
Mailing address:
  • Phone: 404-254-5388
  • Fax: 404-565-1255

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number65598
License Number StateGA

VIII. Authorized Official

Name: NGOZIKA A ORJIOKE
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 770-990-8212