| Providence Care Inc | |
|
216 Nw Broad St Ste B Fairburn GA 30213-4106 | |
| (678) 489-2069 | |
| (678) 489-8627 |
| Full Name | Providence Care Inc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 216 Nw Broad St Ste B, Fairburn, Georgia |
| Authorized Official Name and Position | Stella Ngozi Okpala (DIRECTOR/OWNER) |
| Authorized Official Contact | 4049317854 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Providence Care Inc 216 Nw Broad St Ste B Fairburn GA 30213-4106 Ph: (678) 489-2069 | Providence Care Inc 216 Nw Broad St Ste B Fairburn GA 30213-4106 Ph: (678) 489-2069 |
| NPI Number | 1376805630 |
|---|---|
| Provider Enumeration Date | 06/13/2012 |
| Last Update Date | 06/13/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376805630 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 060-R-1019 (Georgia) | Primary |
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