Organization
ESSENTIA INTIMA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IJEOMA OKWANDU (CMO)
(909) 994-1048
Entity
Organization
Contact information
Practice address
600 LANIER AVE W STE 203, FAYETTEVILLE, GA 30214-1833
(909) 994-1048
Mailing address
600 LANIER AVE W STE 203, FAYETTEVILLE, GA 30214-1833
(909) 994-1048
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
11/04/2024
Last updated
11/04/2024
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