Provider Demographics
NPI:1376928903
Name:MT ZION URGENT CARE CENTER LLC
Entity Type:Organization
Organization Name:MT ZION URGENT CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OLUROPO
Authorized Official - Middle Name:A
Authorized Official - Last Name:AYENI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-880-6924
Mailing Address - Street 1:2759 MOUNT ZION PKWY
Mailing Address - Street 2:SUITE D
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30236-2568
Mailing Address - Country:US
Mailing Address - Phone:770-880-6924
Mailing Address - Fax:
Practice Address - Street 1:2759 MOUNT ZION PKWY
Practice Address - Street 2:SUITE D
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30236-2568
Practice Address - Country:US
Practice Address - Phone:770-880-6924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043534261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care