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General NPI Number Information
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NPI Number | 1376928903
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Entity Type | Organization
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Legal Business Name | MT ZION URGENT CARE CENTER LLC
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Dates
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Enumeration Date | 07/24/2015
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Last Update Date | 07/24/2015
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Provider Practice Location Address
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Address Line | 2759 MOUNT ZION PKWY SUITE D
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City | JONESBORO
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State | GA
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Zip | 30236-2568
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Country | US
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Telephone | 770-880-6924
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Fax |
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Provider Business Mailing Address
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Address Line | 2759 MOUNT ZION PKWY SUITE D
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City | JONESBORO
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State | GA
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Zip | 30236-2568
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Country | US
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Telephone | 770-880-6924
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Fax |
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Authorized Official
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Title or Position | MD/DIRECTOR
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Name | DR. OLUROPO A AYENI
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Credential | M.D
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Telephone | 770-880-6924
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 043534
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License Number State | GA
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