| Favor Family Medical Practice Llc | |
|
103 Mountain Brook Dr Ste 100 Canton GA 30115-9078 | |
| (678) 880-8893 | |
| (678) 880-8589 |
| Full Name | Favor Family Medical Practice Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 103 Mountain Brook Dr Ste 100, Canton, Georgia |
| Authorized Official Name and Position | Eunice Momeh (CEO) |
| Authorized Official Contact | 6788808893 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Favor Family Medical Practice Llc 103 Mountain Brook Dr Ste 100 Canton GA 30115-9078 Ph: (678) 880-8893 | Favor Family Medical Practice Llc 103 Mountain Brook Dr Ste 100 Canton GA 30115-9078 Ph: (678) 880-8893 |
| NPI Number | 1336762913 |
|---|---|
| Provider Enumeration Date | 05/18/2020 |
| Last Update Date | 01/21/2021 |
| Medicare PECOS PAC ID | 7315351012 |
|---|---|
| Medicare Enrollment ID | O20210120001768 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336762913 | NPI | - | NPPES |
| 13911414 | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Ibrahim A Opaleye |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720367287 PECOS PAC ID: 3274705108 Enrollment ID: I20150918001603 |
| Provider Name | Eunice Momeh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457724874 PECOS PAC ID: 3678820842 Enrollment ID: I20180718003467 |
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