Provider Demographics
NPI:1811779598
Name:ULTIMATE URGENT CARE &MEDICAL CLINIC
Entity type:Organization
Organization Name:ULTIMATE URGENT CARE &MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:OKEAKPU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-507-5803
Mailing Address - Street 1:5514 LAWRENCEVILLE HWY NW STE E
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-6024
Mailing Address - Country:US
Mailing Address - Phone:321-507-5803
Mailing Address - Fax:
Practice Address - Street 1:5514 LAWRENCEVILLE HWY NW STE E
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-6024
Practice Address - Country:US
Practice Address - Phone:321-507-5803
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty