Provider Demographics
NPI:1891313276
Name:HEALTH MEDIX CENTER INC
Entity type:Organization
Organization Name:HEALTH MEDIX CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICE
Authorized Official - Prefix:DR
Authorized Official - First Name:BENEDICTA
Authorized Official - Middle Name:N
Authorized Official - Last Name:OKOYE
Authorized Official - Suffix:
Authorized Official - Credentials:DNP FNP-C PMHNP-BC
Authorized Official - Phone:470-429-1431
Mailing Address - Street 1:5401 BOREAL WAY SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-9215
Mailing Address - Country:US
Mailing Address - Phone:470-429-1431
Mailing Address - Fax:
Practice Address - Street 1:5401 BOREAL WAY SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-9215
Practice Address - Country:US
Practice Address - Phone:470-429-1431
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-11
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1922453117Medicaid