Healthcare Provider Details

I. General information

NPI: 1598389637
Provider Name (Legal Business Name): MERCIE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3721 NEW MACLAND RD STE 246
POWDER SPRINGS GA
30127-2000
US

IV. Provider business mailing address

3721 NEW MACLAND RD STE 246
POWDER SPRINGS GA
30127-2000
US

V. Phone/Fax

Practice location:
  • Phone: 770-835-5305
  • Fax: 587-200-1005
Mailing address:
  • Phone: 678-446-4298
  • Fax: 587-200-1005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SYLVIA UDOKORO NWAKANMA
Title or Position: CEO/MEDICAL PROVIDER
Credential: NP
Phone: 770-835-5305