Provider Demographics
NPI:1194235853
Name:COVENANT MEDICAL GROUP LLC
Entity type:Organization
Organization Name:COVENANT MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NGOZIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORJIOKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-990-8212
Mailing Address - Street 1:2330 TALL TIMBERS LN
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-2117
Mailing Address - Country:US
Mailing Address - Phone:770-990-8212
Mailing Address - Fax:
Practice Address - Street 1:3605 SANDY PLAINS RD STE 240-235
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-3068
Practice Address - Country:US
Practice Address - Phone:770-990-8212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-09
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA65598207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty