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General NPI Number Information
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NPI Number | 1245729136
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Entity Type | Organization
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Legal Business Name | GEORGIA COMPREHENSIVE FAMILY CLINIC AND NATURAL HEALTH
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Dates
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Enumeration Date | 05/07/2018
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Last Update Date | 05/07/2018
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Provider Practice Location Address
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Address Line | 1065 PLEASANT HILL RD
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City | LAWRENCEVILLE
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State | GA
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Zip | 30044-3331
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Country | US
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Telephone | 404-547-2859
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Fax |
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Provider Business Mailing Address
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Address Line | 4346 JONES BRIDGE CIR
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City | PEACHTREE CORNERS
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State | GA
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Zip | 30092-1007
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Country | US
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Telephone | 404-547-2859
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Fax |
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Authorized Official
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Title or Position | REGISTERED AGENT
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Name | NAOMI OBIALOR
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Credential | N.P
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Telephone | 404-547-2859
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 206149
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License Number State | GA
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