| First Lithonia Medical Center Inc | |
|
2505 Panola Rd Suite A Lithonia GA 30058 | |
| (770) 323-6458 | |
| (770) 323-6462 |
| Full Name | First Lithonia Medical Center Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 2505 Panola Rd, Lithonia, Georgia |
| Authorized Official Name and Position | Isioma Theresa Okobah (CEO) |
| Authorized Official Contact | 7703236458 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| First Lithonia Medical Center Inc Po Box 965185 Marietta GA 30066-0004 Ph: (678) 984-8079 | First Lithonia Medical Center Inc 2505 Panola Rd Suite A Lithonia GA 30058 Ph: (770) 323-6458 |
| NPI Number | 1427244698 |
|---|---|
| Provider Enumeration Date | 09/20/2007 |
| Last Update Date | 04/29/2024 |
| Medicare PECOS PAC ID | 5890728307 |
|---|---|
| Medicare Enrollment ID | O20050915000273 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427244698 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Isioma T Okobah |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1992797229 PECOS PAC ID: 6406889922 Enrollment ID: I20050920000100 |
| Provider Name | Bethel U Godwins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902310568 PECOS PAC ID: 1557767878 Enrollment ID: I20210910001829 |
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