Healthcare Provider Details

I. General information

NPI: 1003790148
Provider Name (Legal Business Name): GOD FIRST WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2025
Last Update Date: 08/01/2025
Certification Date: 08/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 LANIER AVE W STE 908E
FAYETTEVILLE GA
30214-7641
US

IV. Provider business mailing address

500 LANIER AVE W STE 908E
FAYETTEVILLE GA
30214-7641
US

V. Phone/Fax

Practice location:
  • Phone: 404-273-3388
  • Fax:
Mailing address:
  • Phone: 404-273-3388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: SAMURAT I ONI
Title or Position: PMHNP
Credential: NP
Phone: 321-594-3390