Organization
FAVOR FAMILY MEDICAL PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EUNICE MOMEH NP (CEO)
(678) 880-8893
Entity
Organization
Contact information
Practice address
103 MOUNTAIN BROOK DR STE 100, CANTON, GA 30115-9078
(678) 880-8893
(678) 880-8589
Mailing address
103 MOUNTAIN BROOK DR STE 100, CANTON, GA 30115-9078
(678) 880-8893
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
13911414
—
GA
Enumeration date
05/18/2020
Last updated
01/21/2021
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