Provider Demographics
NPI:1427244698
Name:FIRST LITHONIA MEDICAL CENTER INC
Entity type:Organization
Organization Name:FIRST LITHONIA MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ISIOMA
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:OKOBAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-323-6458
Mailing Address - Street 1:PO BOX 965185
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-0004
Mailing Address - Country:US
Mailing Address - Phone:678-984-8079
Mailing Address - Fax:770-323-6462
Practice Address - Street 1:2505 PANOLA RD
Practice Address - Street 2:SUITE A
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30058
Practice Address - Country:US
Practice Address - Phone:770-323-6458
Practice Address - Fax:770-323-6462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI40419Medicare UPIN