MEDICARE: FAITH FULFILLMENT CENTERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	174200000X	Meals Provider
2	177F00000X	Lodging Provider
3	251300000X	Local Education Agency (LEA)
4	251C00000X	Developmentally Disabled Services Day Training Agency
5	251S00000X	Community/Behavioral Health Agency
6	251B00000X	Case Management Agency
7	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1285578559
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAITH FULFILLMENT CENTERS

Provider Business Mailing Address
First Line	:	120 SHADOW LAKE DR
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30094-4127
Country	:	US
Telephone Number	:	404-396-8888
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 SHADOW LAKE DR
Second Line	:
City	:	CONYERS
State	:	GA
Zip	:	30094-4127
Country	:	US
Telephone Number	:	404-396-8888
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SUNITA PATEL
Credential	:
Telephone Number	:	404-396-8888

Provider Enumeration Date	:	04/16/2026
Last Update Date	:	04/16/2026

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Directions to “FAITH FULFILLMENT CENTERS ” Practice Location

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