=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417748179
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STARS MEDICAL AND PSYCHIATRIC URGENT SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/13/2025
-----------------------------------------------------
Last Update Date | 08/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4330 JOHNS CREEK PKWY STE 400
-----------------------------------------------------
City | SUWANEE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30024-6120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-253-1350
-----------------------------------------------------
Fax | 470-253-1349
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4330 JOHNS CREEK PKWY STE 400
-----------------------------------------------------
City | SUWANEE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30024-6120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 470-253-1350
-----------------------------------------------------
Fax | 470-253-1349
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD/CEO
-----------------------------------------------------
Name | CHRISS ILUNGA MULUMBA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 470-253-1350
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------