Provider Demographics
NPI:1447616255
Name:COVENANT PULMONARY CRITICAL CARE INC
Entity Type:Organization
Organization Name:COVENANT PULMONARY CRITICAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NGOZIKA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ORJIOKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-990-8212
Mailing Address - Street 1:1136 CLEVELAND AVE
Mailing Address - Street 2:SUITE 615
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3618
Mailing Address - Country:US
Mailing Address - Phone:404-254-5388
Mailing Address - Fax:404-565-1255
Practice Address - Street 1:1136 CLEVELAND AVE
Practice Address - Street 2:SUITE 615
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3618
Practice Address - Country:US
Practice Address - Phone:404-254-5388
Practice Address - Fax:404-565-1255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-08
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA65598261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty