Provider Demographics
NPI:1558974709
Name:MEDLIFE HEALTHCARE LLC
Entity Type:Organization
Organization Name:MEDLIFE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAORA
Authorized Official - Middle Name:I
Authorized Official - Last Name:OSAKWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:678-829-4071
Mailing Address - Street 1:2129 FRIENDSHIP RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FLOWERY BRANCH
Mailing Address - State:GA
Mailing Address - Zip Code:30542
Mailing Address - Country:US
Mailing Address - Phone:770-209-2787
Mailing Address - Fax:678-866-2348
Practice Address - Street 1:2129 FRIENDSHIP RD STE 200
Practice Address - Street 2:
Practice Address - City:FLOWERY BRANCH
Practice Address - State:GA
Practice Address - Zip Code:30542
Practice Address - Country:US
Practice Address - Phone:770-209-2787
Practice Address - Fax:678-866-2348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-27
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty