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General NPI Number Information
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NPI Number | 1235955279
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Entity Type | Organization
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Legal Business Name | COVENANT MEDICAL & POPULATION HEALTH INFORMATICS
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Dates
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Enumeration Date | 11/25/2024
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Last Update Date | 11/25/2024
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Provider Practice Location Address
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Address Line | 483 UPPER RIVERDALE RD SW STE K
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City | RIVERDALE
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State | GA
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Zip | 30274-2584
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Country | US
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Telephone | 404-509-0606
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Fax |
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Provider Business Mailing Address
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Address Line | 817 CARLTON POINTE PL
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City | PALMETTO
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State | GA
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Zip | 30268-2356
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Country | US
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Telephone | 404-509-0606
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Fax |
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Authorized Official
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Title or Position | CEO/FOUNDER
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Name | EUNICE YAKUBU
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Credential | MD, PHD
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Telephone | 404-509-0606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174H00000X
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Taxonomy Name | Health Educator
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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