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General NPI Number Information
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NPI Number | 1518467000
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Entity Type | Organization
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Legal Business Name | DIVINE FAMILY HEALTHCARE SERVICES, LLC
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Dates
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Enumeration Date | 02/20/2018
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Last Update Date | 02/20/2018
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Provider Practice Location Address
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Address Line | 1720 MARS HILL RD NW STE 4
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City | ACWORTH
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State | GA
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Zip | 30101-8089
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Country | US
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Telephone | 770-865-3748
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Fax |
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Provider Business Mailing Address
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Address Line | 2733 LOST LAKES DR
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City | POWDER SPRINGS
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State | GA
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Zip | 30127-6012
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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. NGOZI GLORIA OKORO
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Credential | NP
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Telephone | 678-361-0116
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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 | NCO-000001
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License Number State | GA
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