Provider Demographics
NPI:1700691086
Name:CEDAR IN LEBANON LLC
Entity type:Organization
Organization Name:CEDAR IN LEBANON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:IKECHUKWU
Authorized Official - Last Name:NJOKU
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:470-679-0655
Mailing Address - Street 1:2842 BLUE STONE CT
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-7677
Mailing Address - Country:US
Mailing Address - Phone:470-679-0655
Mailing Address - Fax:
Practice Address - Street 1:2842 BLUE STONE CT
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-7677
Practice Address - Country:US
Practice Address - Phone:470-679-0655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care