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General NPI Number Information
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NPI Number | 1174248314
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Entity Type | Organization
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Legal Business Name | SUNHAVEN HEALTHCARE LLC
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Dates
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Enumeration Date | 10/10/2022
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Last Update Date | 10/10/2022
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Provider Practice Location Address
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Address Line | 92 W PACES FERRY RD NW UNIT 7016
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City | ATLANTA
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State | GA
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Zip | 30305-1470
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Country | US
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Telephone | 404-438-7346
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Fax |
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Provider Business Mailing Address
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Address Line | 575 PHARR RD NE UNIT 52906
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City | ATLANTA
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State | GA
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Zip | 30355-4076
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. JENNIFER OKERE
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Credential | NP
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Telephone | 404-438-7346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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