| Mamokant God Favor Health Care Llc | |
|
1018 River Forest Pt Lawrenceville GA 30045-2600 | |
| (941) 237-8179 | |
| Not Available |
| Full Name | Mamokant God Favor Health Care Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1018 River Forest Pt, Lawrenceville, Georgia |
| Authorized Official Name and Position | Marie Jose Antoine (OWNER) |
| Authorized Official Contact | 6782555917 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mamokant God Favor Health Care Llc 1018 River Forest Pt Lawrenceville GA 30045-2600 Ph: () - | Mamokant God Favor Health Care Llc 1018 River Forest Pt Lawrenceville GA 30045-2600 Ph: (941) 237-8179 |
| NPI Number | 1336824077 |
|---|---|
| Provider Enumeration Date | 06/20/2023 |
| Last Update Date | 05/17/2024 |
| Medicare PECOS PAC ID | 5092157743 |
|---|---|
| Medicare Enrollment ID | O20240524003422 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336824077 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Marie Jose Antoine |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922692169 PECOS PAC ID: 8426448168 Enrollment ID: I20211211000042 |
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