Provider Demographics
NPI:1770730517
Name:FATHER'S LOVE MEDICAL CENTER
Entity type:Organization
Organization Name:FATHER'S LOVE MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HEALTH MGT. AND ADMIN.
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIMA
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:OHUABUNWO
Authorized Official - Suffix:
Authorized Official - Credentials:MBBS, MPH, FWACP
Authorized Official - Phone:678-557-9508
Mailing Address - Street 1:7768 HAMPTON PL
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-6770
Mailing Address - Country:US
Mailing Address - Phone:770-466-7737
Mailing Address - Fax:770-466-8824
Practice Address - Street 1:7768 HAMPTON PL
Practice Address - Street 2:SUITE A
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-6770
Practice Address - Country:US
Practice Address - Phone:770-466-7737
Practice Address - Fax:770-466-8824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-23
Last Update Date:2009-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QH0100X, 261QR1100X, 261QC1800X
GA055776261QR1300X
GA060582261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health