Provider Demographics
NPI:1588892293
Name:COVINGTON CLINIC PC
Entity type:Organization
Organization Name:COVINGTON CLINIC PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:OJO
Authorized Official - Last Name:DANIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MS
Authorized Official - Phone:770-688-5558
Mailing Address - Street 1:4480 COVINGTON HWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30035-1218
Mailing Address - Country:US
Mailing Address - Phone:404-775-1973
Mailing Address - Fax:
Practice Address - Street 1:4480 COVINGTON HWY
Practice Address - Street 2:SUITE B
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30035-1218
Practice Address - Country:US
Practice Address - Phone:404-775-1973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2009-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061956261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care