Organization
MC JO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. OBINNA OKECHUKWU OLOWU (ADMINISTRATOR)
(678) 836-9799
Entity
Organization
Contact information
Practice address
4505 RIVER STONE TRL, DOUGLASVILLE, GA 30135-8678
(678) 836-9799
Mailing address
4505 RIVER STONE TRL, DOUGLASVILLE, GA 30135-8678
(678) 836-9799
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
048-R-1373
GA
Other
Enumeration date
08/06/2015
Last updated
08/06/2015
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