Healthcare Provider Details

I. General information

NPI: 1043115090
Provider Name (Legal Business Name): ONE LUCKY SEVEN CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2026
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 E MAIN ST APT D
HAHIRA GA
31632-1273
US

IV. Provider business mailing address

505 E MAIN ST APT D
HAHIRA GA
31632-1273
US

V. Phone/Fax

Practice location:
  • Phone: 678-670-9458
  • Fax:
Mailing address:
  • Phone: 678-670-9458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL

VIII. Authorized Official

Name: SAFDAR HUSSAIN
Title or Position: OWNER
Credential: DO
Phone: 678-670-9458