Provider Demographics
NPI:1104178409
Name:PREMIER FAMILY MEDICINE & URGENT CARE CLINIC INC.
Entity Type:Organization
Organization Name:PREMIER FAMILY MEDICINE & URGENT CARE CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGBEWE
Authorized Official - Middle Name:GODPOWER
Authorized Official - Last Name:OKOROBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-528-7117
Mailing Address - Street 1:1315 DELAUNEY AVE
Mailing Address - Street 2:201A
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-2367
Mailing Address - Country:US
Mailing Address - Phone:706-507-3747
Mailing Address - Fax:706-507-3638
Practice Address - Street 1:1315 DELAUNEY AVE
Practice Address - Street 2:201 A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-2367
Practice Address - Country:US
Practice Address - Phone:706-507-3747
Practice Address - Fax:706-507-3638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-10
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA63508261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care