Provider Demographics
NPI:1730670852
Name:GEO HEALTHCARE LLC
Entity Type:Organization
Organization Name:GEO HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:EBERECHUKWU
Authorized Official - Last Name:OKOYE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:310-384-3058
Mailing Address - Street 1:632 ROCK HILL PKWY
Mailing Address - Street 2:
Mailing Address - City:LITHIA SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30122-3657
Mailing Address - Country:US
Mailing Address - Phone:310-384-3058
Mailing Address - Fax:
Practice Address - Street 1:632 ROCK HILL PKWY
Practice Address - Street 2:
Practice Address - City:LITHIA SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30122-3657
Practice Address - Country:US
Practice Address - Phone:770-948-3717
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-24
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN189783251J00000X
GAF0117133261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No251J00000XAgenciesNursing Care